Histological dating of timed endometrial biopsy tissue is not related to fertility status
Histological dating of timed endometrial biopsy tissue is not related to fertility status
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DOI：
10.1016/j.fertnstert.2004.03.069
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发表时间：
2004-11-01
影响因子：
6.7
通讯作者：
Leppert, PC
中科院分区：
文献类型：
--
作者：
Coutifaris, C;Myers, ER;Leppert, PC
目的：评价组织学定年法对育龄夫妇和不育夫妇的鉴别能力。子宫内膜组织学测定在评估不孕夫妇中的应用尚不确定。设计：前瞻性多中心研究，受试者随机分配活检时间。不孕症的标准是12个月无保护、无受孕的常规性交，2年内至少有一个活产。设置：以大学为基础的不育实践。患者：自愿受试者（847人）在12个临床站点招募，参与国家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，研究前1个月未使用激素治疗或避孕措施。有不孕史、反复流产史或近期母乳喂养史的生育对照组被排除在外。干预措施：受试者每日进行尿LH检测。在检测到黄体生成素激增后，受试者被随机分配到黄体中期（21-22天）或晚期（26-27天）进行活检。每个部位的病理学家根据标准标准估计周期天数。在初步分析中，期外活检被定义为子宫内膜组织学成熟延迟超过2天。主要结局指标：使用随机化时年龄作为协变量的逻辑回归模型比较育龄和不育妇女的期外活检比例。在黄体中期或黄体晚期，还比较了可育和不育的情况。结果：活检评估（中期301例，晚期318例；N = 619例）。在黄体中期（可育期：49.4%，不可育期：43.2%）或黄体晚期（可育期：35.3%，不可育期：23.0%），可育和不育夫妇的异期活检结果难以区分。使用“非同期”或标准化周期日的替代定义，结果没有实质性差异。结论：子宫内膜的组织学测定不能区分不孕夫妇的女性，不应用于不孕的常规评估。(C) 2004年，美国生殖医学学会。
Objective: 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.Design: 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.Setting: University-based inferility 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 infertile couples and should not be used in the routine evaluation of infertility. (C) 2004 by American Society for Reproductive Medicine.