Evaluation of the impact of intraobserver variability on endometrial dating and the diagnosis of luteal phase defects

Scott, Richard T.; Snyder, Russell R.; Bagnall, James W.; Reed, Kurt D.; Adair, Carol F.; Hensley, S

doi:10.1016/s0015-0282(16)56216-5

Cited by 25 publications

(8 citation statements)

References 14 publications

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“…119 Timing of the biopsy appears to alter the degree of variability in histological dating appearance, and the variability of histological dating has been shown to be so large that accuracy and reliability are not sufficient to justify the use of endometrial dating as a bioassay for P action. [120][121][122][123] Thus, despite 60 years of study, the usefulness of endometrial histology for the assessment of infertility remains in doubt.…”

Section: Luteal Phase Defectmentioning

confidence: 99%

Progesterone Function in Human Endometrium: Clinical Perspectives

Young

Lessey

2010

Semin Reprod Med

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Progesterone is essential for endometrial receptivity and successful establishment of pregnancy. Either an insufficient progesterone concentration or an insufficient response to progesterone, therefore can lead to infertility and pregnancy loss. Assessment of the role that either progesterone insufficiency or inadequate progesterone response plays in human reproductive failure has been difficult to assess because serum progesterone concentrations fluctuate markedly, limiting the ability to characterize sufficiency of progesterone, and there are no highly reliable markers of endometrial function available. Recent evidence demonstrates exquisite sensitivity of normal endometrium to very low levels of progesterone stimulation, suggesting that progesterone insufficiency should not be a common cause of reproductive failure. Further evidence suggests that women with endometriosis, and possibly polycystic ovarian syndrome, have an altered progesterone response, which may explain some of the clinical features of these disorders and supports the hypothesis that progesterone resistance underlies some cases of human reproductive failure.

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Section: Luteal Phase Defectmentioning

confidence: 99%

Progesterone Function in Human Endometrium: Clinical Perspectives

Young

Lessey

2010

Semin Reprod Med

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“…This finding invalidated the use of classic histologic dating of timed endometrial biopsies for routine fertility investigation and the diagnosis of a luteal phase defect, but as the authors of the study themselves noted, it did not preclude the possibility that a defect in secretory transformation might cause infertility in at least some instances. And, indeed, the use of Noyes’ criteria for classic histologic dating of the secretory endometrium for diagnostic purposes has long been controversial due to the substantial intersubject, intrasubject, and interobserver variability that limit its precision, as well as concerns about the variability introduced by the endometrial sampling procedure (28-31). The availability, however, of a readily detectable, abundant marker of secretory transformation, the NCS (5), enables a fresh look at the relationship between inadequate secretory transformation and infertility.…”

Section: Introductionmentioning

confidence: 99%

The nucleolar channel system reliably marks the midluteal endometrium regardless of fertility status: a fresh look at an old organelle

Rybak

Szmyga

Zapantis

et al. 2011

Fertility and Sterility

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Objective To determine if nucleolar channel systems (NCSs) in the midluteal endometrium are associated with overall fertility status and/or with unexplained infertility. Design Retrospective and prospective clinical studies. Setting Repository of stored specimens from prior multicenter study and private infertility center, respectively. Patients Retrospective study: 97 women (49 fertile couples, 48 infertile couples) who had been randomized for endometrial biopsy during the midluteal or late luteal phase. Prospective study: 78 women with a variety of infertility diagnoses. Intervention Endometrial biopsies were obtained and assessed for the presence of NCSs by indirect immunofluorescence. Main Outcome Measures NCS presence was graded semi-quantitatively and dichotomized as normal versus low or absent. Results Normal NCS presence was significantly associated with the midluteal phase compared to the late luteal phase (80% versus 29%). However, there was no association between NCS presence and fertility status or between NCS presence and unexplained infertility. Conclusions Midluteal phase endometrium consistently forms NCSs regardless of fertility status, including unexplained infertility. This indicates a possible role for the NCS in initiating the window of endometrial receptivity. However, the consistent presence of NCSs across several different types of infertility challenges the likelihood that inadequate secretory transformation is a cause of infertility.

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“…In particular, they evaluated gland mitoses, pseudostratification of nuclei, basal vacuolation, secretion, stromal edema, pseudodecidual reaction, stromal mitoses, and leukocytic infiltration. Many researchers have used Noyes criteria to analyze the quality of endometrial dating, and have reported a wide range of intraobserver variance, which may have a significant impact on clinical management (6). In a study including 176 infertile women, dating of endometrial biopsies showed that only 64% of patients were in the secretory phase, while the rest (36%) had a secretory delay of at least 2 days (7).…”

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confidence: 99%

Endometrial Dating Method Detects Individual Maturation Sequences During the Secretory Phase

Alfer

Fattahi

Bleisinger

et al. 2020

In Vivo

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Background/Aim: This study assessed whether a new immunohistochemical dating method allows precise endometrial dating allowing optimal timing for embryo transfer. Patients and Methods: A novel method was used for endometrial dating, with parameters including menstrual cycle days, Noyes histological criteria, along with immunohistochemical expression pattern of estrogen and progesterone receptors and proliferation marker Ki-67. Endometrial maturation was analyzed on days +5 to +10 after ovulation or progesterone administration in 217 biopsies from 151 subfertile patients during the secretory phase. Results: Endometrial maturation varied individually, occurring 1.68±1.67 days late. Comparison of histological maturation with clinical days after ovulation showed a delay of about 2 days. Conclusion: Endometrial maturation requires 8 days, rather than the expected 6 days, to reach the histological mid-secretory phase. This is not a delay and is also seen in fertile patients. The new analysis method used is superior to that using Noyes criteria alone and provides a better basis for determining conditions for optimal timing of embryo transfers.

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Evaluation of the impact of intraobserver variability on endometrial dating and the diagnosis of luteal phase defects

Cited by 25 publications

References 14 publications

Progesterone Function in Human Endometrium: Clinical Perspectives

Progesterone Function in Human Endometrium: Clinical Perspectives

The nucleolar channel system reliably marks the midluteal endometrium regardless of fertility status: a fresh look at an old organelle

Endometrial Dating Method Detects Individual Maturation Sequences During the Secretory Phase

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