DOI: https://dx.doi.org/10.18203/2320-1770.ijrcog20160874
Published: 2016-12-27

To study the correlation of mid-cycle luteinizing hormone surge, endometrial thickness and blood flow with histopathological finding of premenstrual endometrial biopsy in patient undergoing evaluation for infertility

Pratiksha Gupta, Chandana Shekhar

Abstract


Background: A prospective study of infertility evaluation: a comparison between premenstrual endometrial biopsy and mid-cycle non-invasive methods. A multicentre study in PGIMSR, GMCH, St stephens hospital, New Delhi, India.

Methods: women attending infertility clinics of age between 20-35 years, with regular menstrual cycles ranging from 21-35 days. Were included, a total of 120 women were enrolled. The study was performed with trans vaginal probe (6.5 MHz), at mid cycle on day 12-14, endometrial thickness was measured, with pattern and Doppler study to evaluate PI (Pulsatility index) and RI (Resistive index) of endometrial myometrial junction, with measurement of LH (Luteinising hormone) level at the same time. Assuming a minimum incidence of 6% with alpha = 0.05; power = 80% & dropout rate = 10% sample size is proposed to include 120 cases. Endometium sampling was done in premenstrual phase.

Results: The high level of LH correlated well with good secretory endometrium and patients with endometrial thickness ≥7 mm and a trilaminar pattern correlated well with secretory endometrium( in phase) and with ET <7 mm had out of phase or non-secretory endometrium. Among blood flow indices low (Pulsatility index) PI is seen to correlate with secretory endometrium. High blood flow impedance was detected in out of phase & non-secretory endometrium.

Conclusions: To conclude mid-cycle non-invasive methods are comparable to premenstrual endometrial biopsy for identification of patient with luteal phase defect.


Keywords


Endometrium, Infertility, Resistive index, Pulsatility index, Luteinizing hormone, Endometium sampling

Full Text:

PDF

References


Decherney AH, Nathan L. Current obstetrics and gynaecology. 2003;979-991.

Berek JS. Infertility, Disorder of endometrial functiombcn and luteal phase defect, 14th edition Philadelphia; Lippincott. 2007;30:1186:180.

Sharif K. Advances in treatment of infertility. Bonnar, ed. Recent Advances in Obstetrics & Gynaecology. Churchill Livingston. 2001:141-56.

Merck A F, Speroff L, Clinical gynaecology endocrinology, Female infertility, 8th edition. 2011;27:1157.

Strauss JF, Yen. Jaff’s Reproductive endocrinology, Female infertility 6th edition, Philadelphia. 2009;21:521.

Jones GES. Some newer aspect of management of infertility. JAMA. 1949;141:1123.

Merck AF, Speroff L. clinical gynaecology endocrinology, Female infertility, 8th edition. 2012;10:390-1.

Hormeyr GJ, Jaff MI, Bezwado WR. Immunologic consequances of recurrent pregnancy loss and consequances of immunization with husbands leukocytes. Fertil Steril. 1987;48:681-4.

Goswamy RK, Williams G, Steptoe PC. Decreased uterine perfusion a cause of infertility. Huma Repro. 1988;3:955-9.

Fluker M, Fisher S. Adult reproductive endocrinology, anovulation & ovulatory dysfunction. 2007;277-88.

Bakos O, Lundkvist O. Bergh The human reproduction. 1993:8(6):799-806.

Probit analysis. World Health Organization, Task Force on Methods for the Determination of the Fertile Period, Special Programme of Research, Development and Research Training in Human Reproduction. Am J Obstet Gynecol. 1980;138(4):383-90.

Guida M, Tommaselli GA, Palomba S, Pellicano M, Moccia G, Di Carlo C, et al. Efficacy of methods for determining ovulation in a natural family planning program. Fertil Steril. 1999;72(5):900-4.

Quintero RB, Sharara FI, Milki AA. Successful pregnancies in the setting of exaggerated endometrial thickness. Fertil. Steril. 2004;82(1):215-7.

Coutifaris C, Myers ER, Guzick DS, Diamond MP, Carson SA, Legro RS, et al. NICHD National Cooperative Reproductive Medicine Network. Histological dating of timed endometrial biopsy tissue is not related to fertility status. Fertil Steril. 2004;82(5):1264-72.

Aghahoseini M, Tuba K, Marsousi V, Aleyasin A. Assessment of endometrial-subendometrial blood flow detected by color doppler sonography and uterine receptivity in infertile women. Acta Medicaa Iranica. 2008;46(6):461-6.

Singh N , Bahadur A, Mittal S , Malhotra N, Bhatt A, Predictive value of endometrial thickness, pattern and sub-endometrial blood flows on the day of hCG by 2D doppler in in-vitro fertilization cycles: A prospective clinical study from a tertiary care unit J Hum Reprod Sci. 2011;4(1):29-33.

Moradan S. Assessment of the relationship between endometrial thickness and number of dominant follicles in pregnancyrate among 361 intrauterine insemination cases. http://www.koomeshjournal.ir/browse.php?a_code=A-10-4-222&slc_lang=en&sid=1&ftxt=1.

Habibzade V, Noureddin S, Mahani N, Kamyab H. The correlation of factors affecting the endometrial thickness with pregnancy outcome in the IUI cycles Iranian Journal of Reproductive Medicine. 2011;9(1):41-6.

Markus AS, Grab D, Schneider V, Strehler E. Predicting the histologic dating of an endometrial biopsy specimen with the use of Doppler ultrasonography and hormone measurements in patients undergoing spontaneous ovulatory cycles Fertility And Sterilityt. 2000;73(1).

Dal J, Vural B, Caliskan E, Ozkan S, Yucesoy I. Power Doppler ultrasound studies of ovarian, uterine, and endometrial blood flow in regularly menstruating women with respect to luteal phase defects. 2005;84(1):224-7.

Yalti S, Gürbüz B, Ficicioglu C, Canova H. Doppler evaluation of the uterine, intraovarian, stromal and spiral arteries on the day of human chorionic gonadotrophin administration in controlled ovarian hyperstimulation. J Obstet Gynaecol. 2003;23(4):402-6.

Elnashar AM, Aboul-Enein GI. Benha and Zagazig University Hospitals, Endometrial receptivity Middle East Fertility Society Journal. 1995;10(4):919-22.

Birol V. Power Doppler studies of ovarian, uterine and endometrial blood flow in regularly menstruating women with respect to LPD, Fertil Steril. 2005,84:224-7.