Peters A J, Lloyd R P, Coulam C B
Center for Reproduction and Transplantation Immunology, Methodist Hospital of Indiana, Inc.
Am J Obstet Gynecol. 1992 Jun;166(6 Pt 1):1738-45; discussion 1745-6. doi: 10.1016/0002-9378(92)91564-q.
We attempted to determine the prevalence of out-of-phase endometrial biopsy specimens among fertile and infertile women and women with recurrent pregnancy loss, histologic dating of biopsies was compared with four reference points for expected ovulation. These reference points included last menstrual period, next menstrual period, luteinizing hormone testing, and ultrasonographic documentation of ovulation.
Four hundred eighty-five endometrial biopsies were performed 7 days after documented ovulation-based ultrasonographic evidence for follicle collapse. The histologic dating was referenced to the last menstrual period, next menstrual period, and ultrasonographic documentation of ovulation. One hundred thirty-two of these women also performed urinary luteinizing hormone surge testing before ovulation and serum progesterone determinations. A comparison of the prevalence of out-of-phase biopsy specimens among groups was determined with the chi 2 test and Fisher's exact test.
The prevalence of out-of-phase endometrial biopsy specimens ranged from 42% when last menstrual period was used to 26% with next menstrual period, to 21% with luteinizing hormone testing, and to 4% with ultrasonographic documentation of ovulation. Serum progesterone values among women with a diagnosis of out-of-phase biopsy specimens by any of the reference dates progesterone were similar to those with in-phase biopsy specimens.
The accuracy of histologic endometrial dating was best determined by ultrasonographic monitoring rather than by last menstrual period, next menstrual period, or luteinizing hormone testing in infertile populations and in those with recurrent pregnancy loss. Additionally, because no significant difference in out-of-phase biopsy specimens exists between fertile and infertile patients and recurrent pregnancy loss, those with the role of this procedure is called into question.
我们试图确定在有生育能力和不孕的女性以及复发性流产的女性中，子宫内膜活检标本不同步的患病率，将活检的组织学日期与预期排卵的四个参考点进行比较。这些参考点包括末次月经、下次月经、促黄体生成素检测以及排卵的超声记录。
在记录到基于卵泡塌陷的超声排卵证据7天后，进行了485次子宫内膜活检。组织学日期参考末次月经、下次月经以及排卵的超声记录。其中132名女性在排卵前还进行了尿促黄体生成素激增检测和血清孕酮测定。通过卡方检验和费舍尔精确检验确定各组间活检标本不同步患病率的比较。
不同步子宫内膜活检标本的患病率从以末次月经为参考时的42%，到以下次月经为参考时的26%，以促黄体生成素检测为参考时的21%，到以排卵超声记录为参考时的4%。在任何参考日期被诊断为活检标本不同步的女性中，血清孕酮值与活检标本同步的女性相似。
在不孕人群和复发性流产患者中，子宫内膜组织学日期的准确性最好通过超声监测来确定，而不是通过末次月经、下次月经或促黄体生成素检测。此外，由于有生育能力和不孕患者以及复发性流产患者之间活检标本不同步没有显著差异，因此该检查方法的作用受到质疑。
