Publication:

To study the correlation of mid-cycle luteinizing hormone surge, endometrial thickness and blood flow with histopathological finding of premenstrual endometrial biopsy in patient undergoing evaluation for infertility

Background A prospective study of infertility evaluation: a comparison between premenstrual endometrial biopsy and mid-cycle non-invasive methods. A multicentre study in PGIMSR, GMCH, St stephens hospital, New Delhi, India.

Methods women attending infertility clinics of age between 20-35 years, with regular menstrual cycles ranging from 21-35 days. Were included, a total of 120 women were enrolled. The study was performed with trans vaginal probe (6.5 MHz), at mid cycle on day 12-14, endometrial thickness was measured, with pattern and Doppler study to evaluate PI (Pulsatility index) and RI (Resistive index) of endometrial myometrial junction, with measurement of LH (Luteinising hormone) level at the same time. Assuming a minimum incidence of 6% with alpha = 0.05; power = 80% & dropout rate = 10% sample size is proposed to include 120 cases. Endometium sampling was done in premenstrual phase.

Results The high level of LH correlated well with good secretory endometrium and patients with endometrial thickness ≥7 mm and a trilaminar pattern correlated well with secretory endometrium( in phase) and with ET <7 mm had out of phase or non-secretory endometrium. Among blood flow indices low (Pulsatility index) PI is seen to correlate with secretory endometrium. High blood flow impedance was detected in out of phase & non-secretory endometrium.

Conclusions To conclude mid-cycle non-invasive methods are comparable to premenstrual endometrial biopsy for identification of patient with luteal phase defect.