Rapid Responses to:

EDITORIALS: Cathy Speed Exercise and menstrual function BMJ 2007; 334: 164-165 [Full text]

Rapid Responses: Submit a response to this article

Rapid Responses published:

Is endometrial biopsy really necessary?

Krzysztof J Jeziorski, Haritha Sagili   (30 January 2007)

Is endometrial biopsy really necessary? 30 January 2007
Krzysztof J Jeziorski, Senior House Officer Nobles Hospital,Isle of Man.IM44RJ, Haritha Sagili Send response to journal: Re: Is endometrial biopsy really necessary?	Speed points out that in women with suspected luteal phase deficiency, ideally endometrial biopsy should be carried out (1). A defective luteal phase (DLP) results from a relative deficiency in secretion of progesterone by the corpus luteum. Endometrial biopsy remains the classical way to diagnose an inadequate luteal phase. Approximately 30 -50% of normal women show on biopsy an occasional DLP. A study (2) which evaluated 1492 biopsies in 1055 women showed that diagnosis of LPD in both infertile and fertile women represents only a chance event; and hence luteal phase evaluation by histological dating of the endometrium is not worthwhile. Moreover because of the discomfort and expense associated with endometrial biopsy, attention has turned to direct measurements of plasma progesterone levels as a means to rule out an inadequate luteal phase. A single plasma progesterone level of 10 ng/ml in the luteal phase or a mean concentration of plasma progesterone of 12-13 ng/ml over 4 days at mid- luteal phase seems to exclude an inadequacy of corpus luteum function (3). A critical analysis of the accuracy, reproducibility, and clinical utility of histologic endometrial dating in 130 fertile women showed that it does not have the accuracy or the precision necessary to provide a valid method for the diagnosis of luteal phase deficiency or to otherwise guide the clinical management of women with reproductive failure (4). References 1. Speed C. Exercise and menstrual function. BMJ. 2007 Jan 27; 334(7586):164-5. 2. Balasch J,Fabregues F, Creus M, Vanrell JA. The usefulness of endometrial biopsy for luteal phase evaluation in infertility. Hum Reprod. 1992 Aug; 7(7):973-7. 3. Crosignani PG. The defective luteal phase. Hum Reprod. 1988 Feb;3(2):157-60. 4. Murray MJ, Meyer WR, Zaino RJ, Lessey BA, Novotny DB, Ireland K, Zeng D, Fritz MA. A critical analysis of the accuracy, reproducibility, and clinical utility of histologic endometrial dating in fertile women. Fertil Steril. 2004 May; 81(5):1333-43. Competing interests: None declared