Secretory Phase and Implantation

Thomas Strowitzki, A. Germeyer, R. Popovici, M. Intensive research work has been performed to better understand the regulation of the endometrium and its clinical implications to improve implantation. Although many proteins and molecules may influence endometrial development, their co-ordinated contribution to the implantation process is still poorly understood and a translation into clinical use has not sufficiently been performed. Clinical evaluation of the endometrium by ultrasound and other techniques, like endometrial biopsy and analysis of uterine secretions, has been intensively studied and therapeutic options to improve endometrial function have been suggested and tested. Systemic treatment with heparin, aspirin or corticosteroids did not result in improved implantation rates.

Diagnosing uterine cancer

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cycles, the effects observed—assessed on endometrial b Endometrial dating expressed in luteal phase days, according to Noyes et al. (). c In global.

A more recent article on endometrial biopsy is available. See patient information handout on endometrial biopsy. Related Content. Endometrial biopsy is an office procedure that serves as a helpful tool in diagnosing various uterine abnormalities. The technique is fairly easy to learn and may be performed without assistance. The biopsy is obtained through the use of an endometrial suction catheter that is inserted through the cervix into the uterine cavity.

Twirling the catheter while moving it in and out of the uterine cavity enhances uptake of uterine tissue, which is aspirated into the catheter and removed. Endometrial biopsy is useful in the work-up of abnormal uterine bleeding, cancer screening, endometrial dating and infertility evaluation. Contraindications to the procedure include pregnancy, acute pelvic inflammatory disease, and acute cervical or vaginal infections.

Postoperative infection is rare but may be further prevented through the use of prophylactic antibiotic therapy. Intraoperative and postoperative cramping are frequent side effects. Endometrial biopsy is a safe and accepted method for the evaluation of abnormal or postmenopausal bleeding.

My approach to the interpretation of endometrial biopsies and curettings

Endometrial thickness is a commonly measured parameter on routine gynecological ultrasound and MRI. The appearance, as well as the thickness of the endometrium, will depend on whether the patient is of reproductive age or postmenopausal and, if of reproductive age, at what point in the menstrual cycle they are examined. The endometrium should be measured in the long axis or sagittal plane, ideally on transvaginal scanning, with the entirety of the endometrial lining through to the endocervical canal in view.

Evaluation of hyperplasias in the post treatment setting in an endometrial biopsy or curettage and avoid diagnostic are inappropriate for endometrial dating.

Received: April 30, ; Published: September 13, J Gynecol Neonatal 1 1 : Postmenopausal bleeding is a frequent clinical problem. Accurate diagnosis is necessary for an adequate clinical management. Currently, 2D ultrasound is considered as a first line imaging technique for discriminating benign situations from malignant lesions.

However, some limitations of this technique exist. Three-dimensional ultrasound is a relatively new technique that allows some unique ways for assessing postmenopausal bleeding by ultrasound. In this article, we shall review current evidence about the use of three-dimensional ultrasound for assessing postmenopausal bleeding. Keywords: Three-dimensional ultrasound; Postmenopausal bleeding; Menopause; Endometrium.

Ultrasound is the most recent cross-sectional imaging technique to obtain three-dimensional 3D capabilities. As against computed tomography CT and magnetic resonance imaging MRI , the ability to stage multiplanar reconstruction from volumetric ultrasound data was progressed significantly more slowly. Current equipment, however, is able to produce high-resolution diagnostic images in three dimensions, comprimising real-time surface-rendered images, whereas CT and MRI still have meager real-time imaging capabilities.

The application of 3D ultrasonography in gynaecology was expedited with the evolution of the endovaginal volume transducer. Its practices in clinical scope continue to expand as new volumetric data manipulation capabilities are added.

Normal Endometrium and Infertility Evaluation

Steven G. Arch Pathol Lab Med 1 March ; 3 : — It is well known that a number of problematic diagnostic scenarios occur relative to these specimens. Recognition of diagnostic pitfalls and practical approaches to their resolution help improve quality. Although most diagnostic pathologists encounter numerous endometrial specimens in their daily practice, many perplexing problems are still encountered when dealing with these specimens.

Endometrial receptivity as an entity began to take shape with the work of Rock and Bartlett (4), who later for- malized a method of endometrial dating in the.

Donate Shop. If your doctor suspects you have uterine cancer, you may have some of the following tests, but you are unlikely to need all of them. The main tests for diagnosing cancer of the uterus are transvaginal ultrasound , examination of the lining of the uterus hysteroscopy and tissue sampling biopsy. A Pap test is not used to diagnose uterine cancer. The doctor will feel your abdomen to check for swelling and any masses. To check your uterus, they will place two fingers inside your vagina while pressing on your abdomen with their other hand.

This is called a bimanual examination. You may also have a vaginal or cervical examination using a speculum, an instrument that separates the walls of the vagina.

Take a look at the Recent articles

Providing cutting-edge scholarly communications to worldwide, enabling them to utilize available resources effectively. We aim to bring about a change in modern scholarly communications through the effective use of editorial and publishing polices. Monique Monard. E-mail : bhuvaneswari. Courtney Marsh.

Here, 2 physicians dissect the data and offer an algorithm of assessment and Histologic dating of an endometrial sample is the gold standard for evaluation of​.

Raga, F. Bonilla-Musoles, E. Klein, F. The aim of the present prospective study was to obtain quantitative data on endometrial volume by three-dimensional 3D ultrasound at the time of embryo transfer in an in-vitro fertilization programme and to assess its value in predicting endometrial receptivity. It is concluded that endometrial volume by 3D transvaginal ultrasound may become a new objective parameter by which to predict endometrial receptivity. Endometrial differentiation, embryo development, and embryo-endometrial interactions leading to implantation require continuous and synchronous dialogue between these two compartments.

Since the introduction of transvaginal sonography, a number of studies have attempted to define a relationship between endometrial thickness, echogenicity and endometrial receptivity. Unfortunately, the sonographic parameters used to predict uterine receptivity still lack specificity, and so the ideal method to predict endometrial receptivity by a non-invasive method has yet to be established.

With the advent and evolution of three-dimensional 3D ultrasound we now stand at a new threshold in non-invasive diagnosis. The standard method of endometrial dating is the histological evaluation of an endometrial biopsy specimen Noyes et al. Indeed, this technique has allowed the demonstration of asynchrony in endometrial development during the course of cycles of ovarian stimulation for IVF leading to cancellation of embryo transfer Frydman et al.

Obviously, the invasiveness of endometrial biopsy is not acceptable in the clinical context of assisted reproduction treatment cycles. As endometrial biopsy is invasive and assessment of the hormonal milieu inadequate, the need to evaluate endometrial development encouraged the use of high-resolution ultrasonography as an alternative, non-invasive method of assessment of endometrial receptivity Shoham et al. Two anatomical parameters have been used to evaluate endometrial receptivity by ultrasound: endometrial thickness and endometrial pattern.

Endometrial Biopsy in Infertile Patients

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.

As a result, morphologic evaluation of the endometrium is used in diagnostic evaluation of infertile patients to determine whether ovulation is occurring Fig. Schematic representation of steroid hormone-morphologic interactions during the endometrial cycle.

Date of Submission, May Date of Web Publication, Jun Assessment of endometrial blood flow adds a physiological dimension to the.

Read terms. This document reflects emerging clinical and scientific advances as of the date issued and is subject to change. The information should not be construed as dictating an exclusive course of treatment or procedure to be followed. Making the distinction between hyperplasia and true precancerous lesions or true neoplasia has significant clinical effect because their differing cancer risks must be matched with an appropriate intervention to avoid undertreatment or overtreatment.

Pathologic diagnosis of premalignant lesions should use criteria and terminology that clearly distinguish between clinicopathologic entities that are managed differently. At present, the endometrial intraepithelial neoplasia schema is tailored most closely to this objective, incorporating modified pathologic criteria based upon evidence that has become available since the creation of the more widely used four-class World Health Organization schema in which atypical hyperplasia is equated with precancerous behavior.

Histologic dating of the endometrium: Accuracy, reproducibility, and practical value

Study record managers: refer to the Data Element Definitions if submitting registration or results information. This study will evaluate the utility of the endometrial biopsy as a tool for the routine evaluation of the luteal phase of women presenting for infertility evaluation. The study will establish whether the mid-luteal or late-luteal phase is the most appropriate time to perform an endometrial biopsy.

The study will be conducted through the multi-center Reproductive Medicine Network. Women with a history of infertility will be age matched to fertile women controls.

Endometrial thickness is well assessed on MRI. Measurement should be taken at a mid-sagittal slice, similar to the ultrasound assessment plane. T2: normal.

Implantation occurs during a specific period of the menstrual cycle, known as the window of implantation between day 6 and day 10 of the cycle, following the luteinizing hormone surge , and is dependent on a synchronized dialogue between the embryo and endometrium. This dialogue is mediated by specific biochemical factors, including hormones, growth factors, enzymes, integrins and cytokines 1 — 3.

Leukemia inhibitory factor LIF , which is a multifunctional protein that belongs to the interleukin 6 cytokine family, exerts numerous regulatory actions on various domains of cellular function 4. LIF was initially reported to induce macrophage differentiation in M1 murine myeloid leukemic cells, and to suppress their proliferation in vitro 5. LIF was later examined in transgenic mice, and was identified as the first necessary cytokine for implantation 6 , 7.

Furthermore, LIF expression has been detected in both the embryo and endometrium, and its role expands from blastocyst development and endometrial differentiation to blastocyst attachment and invasion of the endometrium 4 , 8. LIF exerts its actions by interacting with its receptor, which is a heterodimer composed of two transmembrane proteins, LIF receptor LIF-R and glycoprotein gp 9 — LIF is initially connected to LIF-R with low-affinity binding, which in turn induces dimerization with gp, leading to a high affinity receptor 1 , 4 , 12 , The presence of LIF and LIF-R in endometrial cells, alongside alterations in their expression levels during the menstrual cycle, supports their decisive role in the normal implantation process 18 ,

Endometrial Biopsy

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. In particular, focus will be on the mid-secretory endometrium and appropriate markers and hormonal environment for successful implantation. This will be put in the context of the luteal phase of ovulation and the hormonal support that progesterone provides.

We will also review pathologic states, such as endometriosis and related progesterone resistance, which affect mid-secretory phase and implantation.

As a result, morphologic evaluation of the endometrium is used in diagnostic In a study assessing the accuracy of dating the postovulatory endometrium, the.

Study Design : Prospective, non-randomized clinical study. Materials and Methods : This was a prospective observational study. Women with tubal factor, male factor and unexplained infertility were included in the study. Results : The mean age was 35 years and mean duration of infertility was 8 years. Seventy five The mean endometrial thickness was 8. Overall, 27

Journal of Gynaecology and Neonatal

Metrics details. Over the course of the last four decades, IVF has allowed an increasing number of infertile couples the chance to conceive. Considering the extensive research and advances in ART, too many IVF attempts still do not result in a successful pregnancy [ 1 , 2 ]. Embryo implantation is a crucial event in the establishment of a pregnancy.

The endometrium demonstrates a wide spectrum of normal and pathologic period and RPOC usually causes hemorrhage or infection at a later date. MR imaging is valuable in the evaluation of endometrial cancer.

Nevertheless, there is no consensus regarding the most suitable period of the luteal phase for performing the biopsy. OBJETIVE: This study evaluated the correlation between the histological dating of two endometrial biopsies performed in the same menstrual cycle, on luteal phase days six and ten. Dating was done according to morphometric criteria, in which an endometrium sample is considered out of phase if the minimum maturation delay is one day.

Luteal phase. Female infertility. Evaluation of the luteal phase of regularly cycling women complaining of infertility is directed towards the evaluation of corpus luteum activity and the action of progesterone on the endometrium.

Histopathology Uterus, endometrium–Proliferative endometriu

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