Assessment of endometrial dating

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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. Because of this interplay of structure, function, and ovarian hormonal stimuli, the endometrium is considered one of the most sensitive indicators of the hypothalamic-pituitary-ovarian hormonal axis.

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India Source of Support: Nil. Diagnosis of endometrial receptivity ER has posed a challenge and so far most available tests have been subjective and lack accuracy and a predictive value. Microarray technology has allowed identification of the transcriptomic signature of the window of receptivity window of implantation WOI. Use of this test in patients with recurrent implantation failure RIF has shown that the WOI is displaced in a quarter of these patients and use of a personalized embryo transfer pET on the day designated by ERA improves reproductive performance.

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Nothnick, Robert N. Taylor and Monique Monard. This chapter will explore the latter phase of the menstrual cycle focusing on the secretory phase of the endometrium.

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Thomas Strowitzki, A. Germeyer, R. Popovici, M.

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Synchronous development of the endometrium to achieve a receptive state and of the embryo is essential for successful implantation and ongoing pregnancy. Endometrial receptivity exists only for a finite time in a menstrual cycle and the endometrium is refractory to embryo implantation outside of this window. Administration of hormones to stimulate multifollicular development within the ovary, integral to the majority of assisted reproduction ART protocols, dramatically alters the hormonal milieu to which the endometrium is exposed versus normal menstrual cycles.

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A major proportion of the workload in many histopathology laboratories is accounted for by endometrial biopsies, either curettage specimens or outpatient biopsy specimens. The increasing use of pipelle and other methods of biopsy not necessitating general anaesthesia has resulted in greater numbers of specimens with scant tissue, resulting in problems in assessing adequacy and in interpreting artefactual changes, some of which appear more common with outpatient biopsies. In this review, the criteria for adequacy and common artefacts in endometrial biopsies, as well as the interpretation of endometrial biopsies in general, are discussed, concentrating on areas that cause problems for pathologists. An adequate clinical history, including knowledge of the age, menstrual history and menopausal status, and information on the use of exogenous hormones and tamoxifen, is necessary for the pathologist to critically evaluate endometrial biopsies.

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The endometrium is the inner epithelial layer, along with its mucous membraneof the mammalian uterus. It has a basal layer and a functional layer; the functional layer thickens and then is shed during menstruation in humans and some other mammals, including apesOld World monkeyssome species of batand the elephant shrew. During pregnancythe glands and blood vessels in the endometrium further increase in size and number.

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