Coutifaris Christos, Myers Evan R, Guzick David S, Diamond Michael P, Carson Sandra A, Legro Richard S, McGovern Peter G, Schlaff William D, Carr Bruce R, Steinkampf Michael P, Silva Susan, Vogel Donna L, Leppert Phyllis C
Department of Obstetrics and Gynecology, University of Pennsylvania School of Medicine, Philadelphia 19104, USA.
Fertil Steril. 2004 Nov;82(5):1264-72. doi: 10.1016/j.fertnstert.2004.03.069.
To assess the ability of histological dating to discriminate between women of fertile and infertile couples. The utility of histological dating of endometrium in the evaluation of infertile couples is uncertain.
Prospective multicenter study, with subjects randomly assigned to biopsy timing. Criterion standard for infertility was 12 months of unprotected, regular intercourse without conception and for fertility at least one live birth within 2 years.
University-based infertility practices.
PATIENT(S): Volunteer subjects (847) recruited at 12 clinical sites participating in the National Institutes of Health-funded Reproductive Medicine Network. Inclusion criteria included ages 20-39 years, regular menstrual cycles, and no hormonal treatment or contraceptive use for 1 month before the study. Fertile controls were excluded if they had a history of infertility, recurrent pregnancy loss, or recent breastfeeding.
INTERVENTION(S): Subjects underwent daily urinary LH testing. After detection of the LH surge, subjects were randomized to biopsy in the mid (days 21-22) or the late (days 26-27) luteal phase. Pathologists at each site estimated the cycle day based on standard criteria. For the primary analysis, an out-of-phase biopsy was defined as a greater than 2-day delay in the histological maturation of the endometrium.
MAIN OUTCOME MEASURE(S): The proportion of out-of-phase biopsies in fertile and infertile women was compared using logistic regression models with age at randomization as a covariate. Comparisons were also made between fertile vs. infertile at the midluteal or late luteal phase time points.
RESULT(S): Biopsies were evaluated (301 mid and 318 late; N = 619). Out-of-phase biopsy results poorly discriminated between women from fertile and infertile couples in either the midluteal (fertile: 49.4%, infertile: 43.2%) or late luteal phase (fertile: 35.3%, infertile 23.0%). Results did not substantially differ using alternative definitions of "out-of-phase" or standardized cycle day.
CONCLUSION(S): Histological dating of the endometrium does not discriminate between women of fertile and infertile couples and should not be used in the routine evaluation of infertility.
评估组织学 dating 在区分可育夫妇与不育夫妇中的女性方面的能力。子宫内膜组织学 dating 在不育夫妇评估中的实用性尚不确定。
前瞻性多中心研究，受试者随机分配活检时间。不育的标准为 12 个月无保护、规律性交且未受孕，可育的标准为 2 年内至少有一次活产。
基于大学的不育诊疗机构。
在 12 个临床地点招募的志愿者受试者（847 名），这些地点参与了美国国立卫生研究院资助的生殖医学网络。纳入标准包括年龄 20 - 39 岁、月经周期规律，且在研究前 1 个月未接受激素治疗或使用避孕药。有不育史、复发性流产史或近期哺乳的可育对照被排除。
受试者进行每日尿促黄体生成素（LH）检测。检测到 LH 峰后，受试者被随机分配在黄体中期（第 21 - 22 天）或黄体晚期（第 26 - 27 天）进行活检。每个地点的病理学家根据标准标准估计周期日。对于主要分析，不同期活检被定义为子宫内膜组织学成熟延迟超过 2 天。
使用逻辑回归模型，将随机分组时的年龄作为协变量，比较可育和不育女性中不同期活检的比例。还在黄体中期或黄体晚期时间点对可育与不育进行了比较。
共评估了活检（301 例中期和 318 例晚期；N = 619）。不同期活检结果在区分可育夫妇与不育夫妇的女性方面表现不佳，无论是在黄体中期（可育：49.4%，不育：43.2%）还是黄体晚期（可育：35.3%，不育：23.0%）。使用“不同期”的替代定义或标准化周期日时，结果无实质性差异。
子宫内膜组织学 dating 无法区分可育夫妇与不育夫妇的女性，不应在不育的常规评估中使用。
