Tissue from the fundus of the uterus gives the most reliable information.These critera were used in 300 sterility biopsies taken from normally menstruating women over a 3-year period.Morphologically, the endometrium is one of the most dynamic target tissues in women.Its cyclic structural changes mirror changes in metabolic functions, and both are regulated by ovarian estradiol and progesterone.Infertility is the failure to conceive (regardless of cause) after 1 year of unprotected intercourse.This condition affects approximately 10-15% of reproductive-aged couples.Management of any underlying female and/or male factors affecting fertility may include medical treatment (eg, pharmacotherapy), surgical intervention, or both.If pregnancy has not been established within a reasonable time, consider further evaluation and/or an alternative treatment plan, such as use of donor oocyte, sperm, or embryo, or the use of a gestational carrier or surrogate mother.
Its cyclic structural changes mirror changes in metabolic functions, and both are regulated by ovarian estradiol and progesterone. Schematic representation of steroid hormone-morphologic interactions during the endometrial cycle.
It is asserted that examination of the endometrium during the secretory phase yields more information about the time of ovulation, degree of progestational change, and normality of the endometrium than any other test used in sterility studies.
Attention to qualitative changes in 8 morphological factors is most useful in dating the endometrial biopsy.
This article discusses briefly endogenous hormonal effects (cyclic changes, luteal phase defect, unopposed estrogen effect) and describes the histologic patterns encountered in the most commonly used hormone therapies: oral contraceptives, ovulation stimulation, hormone replacement therapy, and antitumoral hormone therapy.
Oral contraceptives exert a predominant progestational effect on the endometriun, inducing an arrest of glandular proliferation, pseudosecretion, and stromal edema followed by decidualized stroma with granulocytes and thin sinusoidal blood vessels.
Female factors that affect fertility include the following categories: Infertility is a problem that involves both partners.
Diagnostic testing is unnecessary if the couple has not attempted to conceive for at least 1 year, unless the woman is age 35 years or older, or if they have a history of a male factor infertility, endometriosis, a tubal factor, diethylstilbestrol (DES) exposure, pelvic inflammatory disease, or pelvic surgery.
Steroid hormone control of endometrial, epithelial, stromal, and presumably endothelial cells is mediated by estrogen receptors and progesterone receptors.
These steroid receptors are specific proteins concentrated exclusively in the nuclei of endometrial cells (Fig.
Hormone replacement therapy with estrogen alone may result in continuous endometrial proliferation, hyperplasia, and neoplasia.
The use of both estrogen and progesterone elicits a wide range of histologic patterns, seen in various combinations: proliferative and secretory changes, often mixed in the same tissue sample; glandular hyperplasia (in polyps or diffuse) ranging from simple to complex atypical; stromal hyperplasia and/or decidual transformation; epithelial metaplasia (eosinophilic, ciliated, mucinous); and inactive and atrophic endometrium.