Shepard, M. K., & Senturia, Y. D. (1977). Comparison of serum progesterone and endometrial biopsy for confirmation of ovulation and evaluation of luteal function. Fertility and sterility, 28(5), 541-548. https://doi.org/10.1016/s0015-0282(16)42554-9
Shepard MK, Senturia YD. Comparison of serum progesterone and endometrial biopsy for confirmation of ovulation and evaluation of luteal function. Fertil Steril. 1977;28(5):541-548. doi:10.1016/s0015-0282(16)42554-9
Shepard, Marguerite K., and Yvonne D. Senturia. "Comparison of serum progesterone and endometrial biopsy for confirmation of ovulation and evaluation of luteal function." Fertility and sterility, vol. 28, no. 5, 1977, pp. 541-548.
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RRM Academy Synopsis
Blood progesterone fit presumed ovulation timing better than biopsy
A 1977 Texas study of 55 infertile women compared blood progesterone with a same-visit endometrial biopsy. Blood progesterone matched the presumed timing of ovulation more often than biopsy did in these women. Across 33 usable cycles, blood matched in about 9 out of 10 and biopsy in about 4 out of 10.
Key Findings
Among 53 analyzable cycles, blood progesterone confirmed ovulation in 90.5% and biopsy showed secretory endometrium in 81%. The paper calls the difference not significant.
Only 33 cycles had enough data to judge luteal function. Biopsy disagreed with the presumed time of ovulation in 20 of them. Blood progesterone disagreed in 2 of the 33.
Just 13 of 33 biopsies landed inside the 2-day window called normal. Retarded histology, a lining that looked behind schedule, appeared in 48.5% of biopsies.
In 15 cycles with extra blood samples, a single well-timed progesterone value appeared adequately to reflect the serial samples from the same cycle.
Six of the eight women who later had a viable infant showed retarded endometrium in the study cycle.
Interpretation
Women being checked for infertility at one public clinic and one private clinic took part. The researchers dated ovulation afterward from the temperature shift or the next period, so both tests were judged against an estimate. Only 33 cycles from 32 women supported the luteal function comparison. Differences between women with and without another identified cause of infertility were not significant. The authors say the data are too thin to judge luteal phase inadequacy.
RRM Context
Hormone results depend on knowing the day of ovulation. Here, that day came from temperature charts or the next period. Restorative reproductive medicine treats the charted ovulatory cycle as the reference for reading a hormone test.
Our editorial summary of this paper, not the article's abstract.
Abstract
An endometrial biopsy and a blood sample for progesterone determination obtained simultaneously in the midluteal phase of the cycles of 55 infertile women were compared for reliability for confirmation of presumptive ovulation and evaluation of luteal function. Progesterone levels of 3 ng/ml or greater were found in 90.5% of the cycles. Secretory endometrium was identified in 81% of the cycles. Thirty-three cycles yielded sufficient information to compare the two methods for evaluation of luteal function. Histology and progesterone levels were consistent with each other and the presumed time of ovulation in only 11 cycles. Histology was inconsistent with the presumed time of ovulation in 20 cycles, while progesterone was inconsistent in only two cycles. Additional samples for progesterone determinations were obtained during the biopsy cycles of 15 patients who presented adequate data for evaluation of luteal function. A single, well-timed progesterone determination appeared adequately to reflect the data obtained from serial samples in the same cycle. These results support the thesis that a single, well-timed serum progesterone determination is superior to a single endometrial biopsy as a screening method for confirmation of presumptive ovulation and for evaluation of luteal function.
Endometrial biopsy specimens were obtained from 107 normally menstruating infertile women 2 to 3 days before the anticipated onset of menses and were day-dated according to histologic criteria. A simultaneous blood sample was obtained for measurement of progesterone (P) and beta-subunit of human chorionic gonadotropin. Of 98 biopsies which could be accurately dated, 56 were in-phase (IP) and 42 were out-of-phase (OOP). Mean serum P levels were significantly lower in women with OOP biopsies undertaken more than 4 days before the onset of menses. A sharp decline in serum P levels was observed in women with IP but not OOP biopsies, so that on the final premenstrual day serum P levels were significantly higher than normal in women with OOP biopsies. Pregnancy continued without interruption in two of six patients who underwent biopsy in the cycle of conception. One patient had an ectopic pregnancy; and the three remaining pregnant patients, all with subnormal P values, aborted. The study suggests that there is a high frequency of minor abnormalities in luteal function in normally menstruating, infertile women for whom tubal and male factors were normal. The frequency of subclinical pregnancy (2 of 107) was lower than anticipated from earlier studies.
To investigate whether luteal and endometrial abnormalities occur more frequently in an infertile population and thus contribute to infertility. Prospective controlled clinical study. Outpatient clinic in an academic research institution. Thirty-three fertile controls and 31 infertile women without ovulatory disorders, tubal disease, or male factors. 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. Histologic dating of the endometrium and serum P and PP14 measurements. 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. 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.
To develop a practical yet statistically valid means of indicating ovulation and adequacy of corpus luteum function concentrations of plasma progesterone (P) were measured daily during the luteal phase of 30 normal and abnormal menstrual cycles. During a normal cycle any 3 P measurements taken from 11 days before the first day of the following menses (M) to Day M-4 gave a total equal to or greater than 15 ng/ml. An abnormal cycle was considered one in which the total P (for 3 measurements) was less than 15 ng. Individual levels were often at 3 ng/ml in normal cycle and above 3 ng/ml in abnormal cycles indicating that the single P measurement proposed by Israel et. al. would not always be valid.
A study was undertaken to determine whether solitary progesterone as says performed on serum samples obtained in the midluteal phase would provide the clinician with a convenient indicator that ovulation had occurred in that cycle. After a normal luteal-phase range was establish ed, single luteal-phase serum progesterone sampling was performed in 51 infertile women with regular menses and 35 oligomenorrheic women undergoing clomiphene citrate therapy. In the follicular phase of the cycle, progesterone levels were consistently less than 2 ng/ml. Between 11 and 4 days prior to the onset of menses in presumptively ovulatory cycles, serum progesterone levels were always 3 ng/ml or greater. Progesterone values in this range were always accompanied by a secretory endometrium and can be considered presumptive evidence of ovulation. This rapid, easily performed technique enables 1 technician to assay 30 or more samples for progesterone in a single working day and the results are available within 24 hours. This assay technique is easier to perform and more reproducible than a urinary pregnanediol assay, and it is expected that clinical laboratories will soon perform serum progesterone assays as a routine procedure.
PMID 856637 856637 DOI 10.1016/s0015-0282(16)42554-9 10.1016/s0015-0282(16)42554-9 Shepard et al. 1977, Shepard 1977
Cite this article
Shepard, M. K., & Senturia, Y. D. (1977). Comparison of serum progesterone and endometrial biopsy for confirmation of ovulation and evaluation of luteal function. Fertility and sterility, 28(5), 541-548. https://doi.org/10.1016/s0015-0282(16)42554-9
Shepard MK, Senturia YD. Comparison of serum progesterone and endometrial biopsy for confirmation of ovulation and evaluation of luteal function. Fertil Steril. 1977;28(5):541-548. doi:10.1016/s0015-0282(16)42554-9
Shepard, Marguerite K., and Yvonne D. Senturia. "Comparison of serum progesterone and endometrial biopsy for confirmation of ovulation and evaluation of luteal function." Fertility and sterility, vol. 28, no. 5, 1977, pp. 541-548.
Keywords
Adult, Biopsy, Corpus Luteum/physiopathology, Endometrium/pathology, Female, Humans, Infertility, Female/blood/pathology/physiopathology, Middle Aged, Ovulation Detection, Progesterone/blood, Progesterone, Age Factors, Biology, Clinical Research, Comparative Studies, Corpus Luteum, Endocrine System, Endometrial Effects, Endometrium, Examinations And Diagnoses, Genitalia, Genitalia, Female, Hematological Effects, Hemic System, Hormones, Infertility, Laboratory Examinations And Diagnoses, Laboratory Procedures, Ovulation Detection, Parity, Physiology, Progestational Hormones, Progesterone--analysis, Reproduction, Research Methodology, Studies, Urogenital System, Uterus, Women
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