Endometrial dating infertility

As hormone therapy changes over time, with new regimens continuously being implemented, the effect on the endometrium can result in unpredictable structural changes.The histologic patterns of the endometrium associated with hormone therapy vary with the dosage, duration of therapy, and individual hormone receptor activity.Ovulation induction therapy accelerates the maturation of the stroma and is often associated with a discrepancy between early secretory glands and an edematous or decidualized stroma with spiral arterioles.Hormone replacement therapy with estrogen alone may result in continuous endometrial proliferation, hyperplasia, and neoplasia.The individual cell mass increases as does the nuclear-cytoplasmic ratio.Numerous mitoses are seen throughout the glands and stroma.Both endometrioid and nonendometrioid carcinomas are seen, often in polyps.Their causal relationship to tamoxifen therapy is debatable.

Perhaps the most significant change in terms of adequacy of the luteal phase is that involving the blood vessels.The same endometrium may display a number of changes under different conditions, resulting in a diversity of histologic patterns that may render some endometrial biopsies difficult to interpret.Although the endometrial response may vary from patient to patient, certain general histologic patterns for specific hormone therapies can be recognized.The endometrial thickness increases more than 10-fold as a result of active growth of glands, stroma, and blood vessels.The proliferative phase has a variable length from 10 to 20 days, with an ideal duration of 14 days.

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