Batista, M. C., Cartledge, T. P., Zellmer, A. W., Merino, M. J., Nieman, L. K., Loriaux, D. L., & Merriam, G. R. (1996). A prospective controlled study of luteal and endometrial abnormalities in an infertile population. Fertility and Sterility, 65(3), 495-502. https://doi.org/10.1016/s0015-0282(16)58143-6
Batista MC, Cartledge TP, Zellmer AW, Merino MJ, Nieman LK, Loriaux DL, Merriam GR. A prospective controlled study of luteal and endometrial abnormalities in an infertile population. Fertil Steril. 1996;65(3):495-502. doi:10.1016/s0015-0282(16)58143-6
Batista, M. C., et al. "A prospective controlled study of luteal and endometrial abnormalities in an infertile population." Fertility and Sterility, vol. 65, no. 3, 1996, pp. 495-502.
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RRM Academy Synopsis
Uterine lining maturation was abnormal more often in infertile women
Abnormal uterine lining growth showed up in about 4 of 10 infertile women, versus about 1 of 10 fertile women, in a 1996 study. All 63 women ovulated and had one biopsy. The infertile women had no ovulation problem, tube disease or male factor.
Key Findings
Abnormal endometrial biopsies occurred in 13 of 30 infertile women (43%) and 3 of 33 fertile women (9%), P < 0.01.
Abnormal findings were equally common in infertile women under 35 and 35 or older (44% versus 43%).
A weak progesterone response to the hCG stimulation test occurred in 1 of 30 infertile women and 3 of 33 fertile women (3% versus 9%).
Only 1 of 15 women with delayed or dysynchronous lining development had a reduced progesterone response after hCG.
Placental protein 14 levels varied widely and did not clearly separate normal from abnormal biopsies.
Interpretation
This study followed 33 fertile women and 31 infertile women. One infertile woman got pregnant during the study and was taken out. The infertile women had no ovulation problem, tube disease or male factor. Nine had mild endometriosis. The authors found that a lining problem happens more often in infertile women. The lining problem did not come with a matching corpus luteum problem. They said it may add to infertility. The findings support larger studies of this lining problem in unexplained infertility.
RRM Context
Thirteen of 30 infertile women had an abnormal lining on biopsy. None had a known cause of infertility. This fits the RRM view that unexplained infertility means undiagnosed. In this study, abnormal biopsies usually did not come with a weak corpus luteum, the gland tissue that makes progesterone after ovulation.
Our editorial summary of this paper, not the article's abstract.
Abstract
Objective
To investigate whether luteal and endometrial abnormalities occur more frequently in an infertile population and thus contribute to infertility.
Design
Prospective controlled clinical study.
Setting
Outpatient clinic in an academic research institution.
Participants
Thirty-three fertile controls and 31 infertile women without ovulatory disorders, tubal disease, or male factors.
Interventions
All women underwent an endometrial biopsy 9 days after the LH surge followed by an IM injection of 5,000 IU hCG. Blood samples were drawn immediately before hCG administration for serum P and placental protein 14 (PP14) measurements, at 6 hours after hCG stimulation for serum P concentrations, and on day 5 after hCG administration for serum PP14 levels.
Main Outcome Measures
Histologic dating of the endometrium and serum P and PP14 measurements.
Results
Abnormal endometrial biopsies occurred more frequently in infertile (43%) than in fertile women (9%). Except for one case, these specimens were not associated with low hCG-stimulated P levels. Serum PP14 measurements varied widely and did not discriminate subjects with abnormal endometrial development.
Conclusions
Disruption of endometrial maturation without a concomitant defect of the corpus luteum occurs more frequently in an infertile population and thus may contribute to infertility.
