Three-dimensional ultrasound assessment of endometrial receptivity: a review

References Abstract Over the last decade, research to improve success rates in reproductive medicine has focused predominantly on the understanding and optimization of embryo quality. However, the emergence of personalized medicine in ovulation induction and embryology has shifted the focus to assessing the individual status of the endometrium. The endometrium is considered receptive during an individually defined period, the window of implantation WOI , when the mother permits a blastocyst to attach and implant. This individual receptivity status can now be objectively diagnosed using the endometrial receptivity array ERA developed in The ERA, together with a computational algorithm, detects the unique transcriptomic signature of endometrial receptivity by analyzing differentially expressed genes and reliably predicting the WOI. We and others have illustrated the utility of this personalized diagnostic approach to discriminate between individual physiological variation in endometrial receptivity and unknown endometrial pathology, deemed as causal in recurrent implantation failure RIF. NCT is underway to determine the clinical value of this endometrial diagnostic intervention in the work-up for reproductive care. In this review, we analyse the current clinical practice in the diagnosis of the endometrial factor together with new avenues of research. The most investigated element in the implantation triad is the embryo, which seeks to adhere to the endometrial epithelium and invade the decidualized stroma, initiating trophoblast invasion and placentation. Indeed, the understanding of human pre-implantation development is critical for review see [ 2 ] , as are the soluble ligands produced and received by their receptors to mediate this fundamental process for review see [ 3 ].


This technique allows for the most thorough sampling of the endometrium but requires anesthesia for cervical dilation. The curette is drawn across the anterior and posterior endometrial surfaces, scraping the tissue free. Fractional sampling is especially useful for evaluating possible endocervical pathology, such as extension of endometrial adenocarcinoma to the endocervix.

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To study and compare the concordance of various histomorphological patterns in endometrial curettage and the subsequent hysterectomy specimen in dysfunctional uterine bleeding and hence to evaluate the causes for the disconcordance. All the cases which presented with DUB from January to December and which underwent endometrial curettage and subsequent hysterectomy were studied and analyzed for concordance and disconcordance.

The consistency rate of the endometrial tissue from the curettage and the hysterectomy specimens was only modest. This rate was lower in simple hyperplasia as compared to complex hyperplasia. Keywords Endometrial hyperplasia, Fractional curettage, Hysterectomy, Concordance. How to cite this article:

Electron Microscopy of Human Endometrium during Window of Implantation

Proliferative Phase Proliferative phase change. The glands are simple appearing as circles in cross-section. Mitotic activity is conspicuous. In the endometrium, proliferative activity occurs even before the complete cessation of menstruation, i. The glands at this earlier stage are relatively straight or, at most, slightly coiled and are found within relatively loose endometrial stroma. As the name suggests, there is brisk cell division with prominent mitotic activity in both the glands and the stroma.

AbstractObjective: To compare the expression of progesterone receptors (A + B) and type-B progesterone receptors in the epithelial and stromal cells of fertile and infertile s: Women were divided into two groups, the group of fertile controls (group 1) and the group of infertile women (group 2) and were set on regular ultrasound imaging in order to detect ovulation.

Although this technique will not probably replace two-dimensional ultrasound, it is being increasingly used. It has been reported that 3D US is a very high reproducible technique. The endometrium has been paid special attention when using this technique. The aim of this paper is to address some technical aspects of 3D US and to review critically its current status in evaluating endometrial function with special focus in its role in predicting pregnancy in assisted reproductive techniques.

In spontaneous cycles endometrial volume grows during follicular phase remaining constant through the luteal phase. Endometrial vascularization increases during follicular phase peaking 2—3 days before ovulation, decreasing thereafter and increasing again during mid and late luteal phase. An explanation for these controversial findings might be different design of reported studies, specially the timing of ultrasound evaluation.

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Product of conception Villi Decidua 25 Post-menopausal cystic atrophy: Swiss-cheese endometrium mimics simple hyperplasia: Swiss-cheese endometrium mimics simple hyperplasia 26 Aglandular endometrium: Submucosal leiomyoma 27 Common artifacts: Accurate dating not possible Contaminants: Common artifacts Telescoping artifact Artifactual compression 29 Artifacts can be misleading and thus repeat biopsy will be justified if proper evaluation ofendometrium is hampered.

1) Histology of normal and abnormal endometrium (including endometrial dating) 2) Current data relating to the effects of estrogen and progestins on endometrial hyperplasia and adenocarcinoma.

Endometrial expression profiling in women with recurrent early pregnancy loss. The endometriums ability to acquire a receptive state during the mid-secretory phase is a crucial component of successful implantation and, therefore, has been the focus of many studies that aim to identify predictive markers of early pregnancy. In order to better understand the molecular mechanisms that are perturbed in REPL, we examined the gene expression profiles of mid-secretory phase endometrium in patients with different diagnoses of endometrial dysfunction.

Differentially expressed DE genes were identified using a likelihood ratio test within a fixed-effects linear model framework. The two genes with the largest differential expression were S P 3. S P expression peaks in the endometrium during the window of implantation Tong et al. LEFTY2 levels normally decrease during that phase, and aberrantly high expression levels were observed in patients with implantation failure and infertility Tabibzadeh et al. Taken together, the results of this study suggest that this is a promising approach for identifying genes and pathways whose tight regulation during the endometrial secretory phase is necessary for optimal implantation and successful pregnancy outcome.

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Endometrium: Secretory phase

Every patient is different and what Bob and Juancho suggested may or may not work. The issue is whether this endometrium has got enough progesterone receptors to decidualize and allow the embryo to implant. If the molecular analysis tells me that the endometrium is receptive, I have ethical reasons to proceed with embryo replacements. We published many years ago pregnancies in oocyte donation with thin 4 mm endometria.

Histologic dating was not able to discriminate between a fertile or infertile status, and therefore they postulate that timed endometrial biopsy followed by dating of the endometrium does not provide clinically useful information as a screening test.

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The authors defined the differences in endometrial dating, as follows: for the R group, histological dating other than the postovulatory day (POD) 5; for the NR group, histological dating that was different from the result of the ERA (ie histologically POD 5 in spite of the ERA diagnosis of NR).

Accessed November 9th, Diagrams Phases Proliferative phase: Early proliferative endometrium Mid proliferative days 8 – Mid proliferative endometrium and Ki67 staining Late proliferative days 11 – Day 10 – 12 endometrium shows glands that are more tortuous and crowded; intraglandular nuclear pseudo- stratification and mitotic activity are more prominent see inset and the stroma is edematous and mitotically active Ovulation: Traditionally assumed to be 14 days, but may vary Progesterone secretion inhibits endometrial proliferative activity and induces secretory activity Note: Contributed by Andrey Bychkov, M.

Day 17 endometrium, with reduced Ki67 staining Day These regularly tortuous glands in this day 20 endometrium contain secretions that are largely intracellular apical, and partially intraluminal Day

endometrial curettage

El Nashar, Althawra St. Endometrial receptivity is a temporally unique sequence of factors that make the endometrium receptive to embryonic implantation. Implantation window is a period during which the endometrium is optimally receptive to implanting blastocyst D postovulation. No conclusive evidence of age related histological changes in the endometrium.

endometrium, biopsy: consistent with menstrual phase endometrium: – weakly proliferative endometrial glands with neutrophils and apoptosis. — balls of condensed endometrial stroma. — blood. endometrium, biopsy: very weakly proliferative endometrial glands with neutrophils and apoptosis. – balls of condensed endometrial stroma and blood.

The aim of this study was the evaluation of endometrial histopathologic findings from patients treated with tamoxifen Tx for breast cancer from two METHODS: Effect of tamoxifen on endometrial histology, hormone receptors, and cervical cytology: Represents hyperplastic response of normal endometrial tissue to unopposed estrogen; Patients with tamoxifen therapy are more prone to develop polyps; Late menopause, hormone replacement therapy and obesity increase risk of Microscopic histologic description.

For nearly 20 years, tamoxifen has been successfully used in the management of breast cancer. Anatomy and histology of the uterine corpus. Blaustein’s pathology of the female genital tract. There were no cases of hyperplasia in the placebo group. The aim of this study was to evaluate the effect of tamoxifen on the endometrium of post-menopausal women with breast cancer and to examine the relationship between ultrasonography, hysteroscopy and histopatho- logic changes.

We also analyzed risks of endometrial cancer of different histologic subtypes, as categorized elsewhere 18 , Adenomyomatous Polyp of the Uterus in a Patient Receiving…We report a case of adenomyomatous polyp that developed during treatment with tamoxifen for breast cancer. A year-old Japanese woman was admitted. Histologic examination revealed the tumor to be composed of endometrial glands admixed with smooth muscle cells.

For all patients, gynaecological history, years of adjuvant treatment, ultrasound endometrial thickness measurement and indications for hysteroscopy were recorded.

Biology of Reproduction

To reassess endometrial morphological criteria of normality identifying the best To date endometrium , should see surface endometrium , but date based on most advanced area; Must biopsy uterine corpus above the level of the isthmus; must. Endometrial maturation, important in the diagnosis of infertile couples , has been evaluated since using the Noyes criteria.

It estimates scores for the different. Am J Obstet Gynecol.

endometrial biopsy was performed using dating technique. Results: Ninety eight (%) out of the five hundred and fifty subjects had measurable hormonal abnormalities.

This descriptive study evaluates the impact on endometrial development of standard and high doses of a GnRH antagonist in stimulated cycles compared with GnRH agonist and natural cycles. Thirty-one oocyte donors were treated with a combination of rFSH and 0. Endometrial biopsies were performed 2 and 7 days after HCG administration. Additional biopsies were carried out in a subset of 12 subjects, 2 and 7 days following the LH peak of their previous natural cycle. Biopsies were evaluated histologically and by scanning electron microscopy.

Gene expression profiles were also studied. In buserelin group, endometrial dating and pinopode expression suggested an arrested endometrial development. For window of implantation genes, expression patterns were closer to those in the natural cycle following standard- or high-dose ganirelix than after buserelin administration.

No relevant alteration was observed in the endometrial development in the early and mid-luteal phases in women undergoing controlled ovarian stimulation for oocyte donation following daily treatment with a standard- or high-dose GnRH antagonist. In addition, the endometrial development after GnRH antagonist mimics the natural endometrium more closely than after GnRH agonist.


Your browser does not support iframes. A panel of immunohistochemical stains including carcinoembryonic antigen, vimentin, and estrogen receptor aids in the distinction between primary endometrial and endocervical adenocarcinomas. Affinity of four lectins for endocervical and endometrial non-neoplastic and neoplastic glandular epithelium.

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Adapted from Witkin et al. Unsuspected Chlamydia trachomatis infection and in vitro fertilization outcome. Am J Obstet Gynecol Nongonococcal-nonchlamydial salpingitis may also arise de novo as a primary infection. There is less fever, vaginal discharge, and liver tenderness than with gonococcal PID. Despite these differences, the clinical presentation does not adequately distinguish between the two, and reliance on culture is necessary.

Except for the presence of N.

Endometrial Biopsy