Normal Endometrium and Infertility Evaluation

  • Michael T. Mazur
  • Robert J. Kurman


The histologic features of what constitutes “normal” endometrium change with a woman’s age, through the premenarchal, reproductive, perimenopausal, and postmenopausal years.1–3 During the reproductive years, the cyclical hormonal changes of the menstrual cycle provide a continuously changing morphologic phenotype which is “normal.” The combination of these changes with artifacts and sampling limitations can make normal patterns difficult to interpret. During the reproductive years, deviations from normal, either in histologic pattern or in temporal relationship to ovulation, often indicate underlying abnormalities that may cause female infertility.


Secretory Phase Proliferative Phase Endometrial Biopsy Normal Endometrium Lower Uterine Segment 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Noyes RW, Hertig AT, Rock J: Dating the endometrial biopsy. Fertil Steril 1950;1:3–25.Google Scholar
  2. 2.
    Dallenbach-Hellweg G: Histopathology of the Endometrium. 4th ed. New York: Springer-Verlag, 1987.CrossRefGoogle Scholar
  3. 3.
    Hendrickson MR, Kempson RL: Surgical Pathology of the Uterine Corpus (Major Problems in Pathology series). Volume 12. Philadelphia: W.B. Saunders, 1980.Google Scholar
  4. 4.
    Speroff L, Glass RH, Kase NG: Clinical Gynecologic Endocrinology and Infertility. 4th ed. Baltimore: Williams & Wilkins, 1989.Google Scholar
  5. 5.
    Merrill JA: The interpretation of endometrial biopsies. Clin Obstet Gynecol 1991;34:211–221.PubMedCrossRefGoogle Scholar
  6. 6.
    Hill GA, Herbert CM III, Parker RA, Wentz AC: Comparison of late luteal phase endometrial biopsies using the Novak curette or Pipelle endometrial suction curette. Obstet Gynecol 1989;73: 443–446.PubMedGoogle Scholar
  7. 7.
    Hecht BR, Bardawil WA, Khan-Dawood FS, Dawood MY: Luteal insufficiency: Correlation between endometrial dating and integrated progesterone output in clomiphene citrate-induced cycles. Am J Obstet Gynecol 1990; 163:1986–1991.PubMedGoogle Scholar
  8. 8.
    Shoupe D, Mishell DR, Jr, Lacarra M, Lobo RA, Horenstein J, et al: Correlation of endometrial maturation with four methods of estimating day of ovulation. Obstet Gynecol 1989;73:88–92.PubMedGoogle Scholar
  9. 9.
    Peters AJ, Lloyd RP, Coulam CB: Prevalence of out-of-phase endometrial biopsy specimens. Am J Obstet Gynecol 1992; 166:1738–1746.PubMedGoogle Scholar
  10. 10.
    Masterson R, Armstrong EM, More IAR: The cyclical variation in the percentage of ciliated cells in the normal human endometrium. J Reprod Fertil 1975;42:537–540.CrossRefGoogle Scholar
  11. 11.
    Hendrickson MR, Kempson RL: Ciliated carcinoma—a variant of endometrial adenocarcinomal: A report of 10 cases. Int J Gynecol Pathol 1983;2:1–12.PubMedCrossRefGoogle Scholar
  12. 12.
    Kurman RJ, Norris HJ: Endometrial hyperplasia and metaplasia. In: Blaustein’s Pathology of the Female Genital Tract. 4th ed. Kurman RJ, ed. New York: Springer-Verlag, 1994;411–437.CrossRefGoogle Scholar
  13. 13.
    Silverberg SG, Kurman RJ: Tumors of the uterine corpus and gestational trophoblastic disease. Atlas of Tumor Pathology, 3rd series, Fascicle 3. Washington, DC: Armed Forces Institute of Pathology, 1992.Google Scholar
  14. 14.
    Buckley GH, Fox H: Biopsy Pathology of the Endometrium. New York: Raven Press, 1989; 234–247.Google Scholar
  15. 15.
    Bulmer JN, Lunny DP, Hagin SV: Immunohisto-chemical characterization of stromal leucocytes in nonpregnant human endometrium. Am J Reprod Immmunol Microbiol 1988;17:83–90.Google Scholar
  16. 16.
    King A, Wellings V, Gardner L, Loke YW: Immunocytochemical characterization of the unusual large granular lymphocytes in human endometrium throughout the menstrual cycle. Hum Immunol 1989;24:195–205.PubMedCrossRefGoogle Scholar
  17. 17.
    Bulmer JN, Hollings D, Ritson A: Immunocyto-chemical evidence that endometrial stromal granulocytes are granulated lymphocytes. J Pathol 1987;153:281–288.PubMedCrossRefGoogle Scholar
  18. 18.
    Poropatich C, Rojas M, Silverberg SG: Polymorphonuclear leukocytes in the endometrium during the normal menstrual cycle. Int J Gynecol Pathol 1987;6:230–234.PubMedCrossRefGoogle Scholar
  19. 19.
    Numers GV: On the traumatic effect of curettage on the endometrial biopsy, with special reference to so-called invagination pictures and the “crumbling endometrium.” Acta Obstet Gynecol Scand 1942;28:305–313.CrossRefGoogle Scholar
  20. 20.
    Jones GS: Luteal phase insufficiency. Clin Obstet Gynecol 1972;16:255–273.CrossRefGoogle Scholar
  21. 21.
    Wentz AC: Diagnosing luteal phase inadequacy. Fertil Steril 1982;37:334.PubMedGoogle Scholar
  22. 22.
    Wentz AC, Kossoy LR, Parker RA: The impact of luteal phase indaequacy in an infertile population. Am J Obstet Gynecol 1990;162:937–945.PubMedGoogle Scholar
  23. 23.
    Kurman RJ, Mazur MT: Benign diseases of the endometrium. In: Blaustein’s Pathology of the Female Genital Tract. 4th ed. Kurman RJ, ed. New York: Springer-Verlag, 1994;367–409.CrossRefGoogle Scholar
  24. 24.
    Daly DC, Walters CA, Soto-Albors CE, Riddick DH: Endometrial biopsy during treatment of luteal phase defects is predictive of therapeutic outcome. Fertil Steril 1983;40:305–310.PubMedGoogle Scholar
  25. 25.
    Rosenfeld DL, Garcia C: A comparison of endometrial histology with simultaneous plasma progesterone determinations in infertile women. Fertil Steril 1976;27:1256–1266.PubMedGoogle Scholar
  26. 26.
    Annos T, Thompson IE, Taymor ML: Luteal phase deficiency and infertility: Difficulties encountered in diagnosis and treatment. Obstet Gynecol 1981;55:705–710.Google Scholar
  27. 27.
    Rosenfeld DL, Chudow S, Bronson RA: Diagnosis of luteal phase inadequacy. Obstet Gynecol 1980;56:193–196.PubMedGoogle Scholar
  28. 28.
    Cooke ID, Morgan CA, Parry TE: Correlation of endometrial biopsy and plasma progesterone levels in infertile women. J Obstet Gynaecol Br Commonw 1972;79:647–650.PubMedCrossRefGoogle Scholar
  29. 29.
    Cumming DC, Honore LH, Scott JZ, Williams KP: The late luteal phase in infertile women: Comparison of simultaneous endometrial biopsy and progesterone levels. Fertil Steril 1985;43:715–719.PubMedGoogle Scholar
  30. 30.
    Wentz AC: Endometrial biopsy in the evaluation of infertility. Fertil Steril 1980;33:121–124.PubMedGoogle Scholar
  31. 31.
    Witten BI, Martin SA: The endometrial biopsy as a guide to the management of luteal phase defect. Fertil Steril 1985;44:460–465.PubMedGoogle Scholar
  32. 32.
    Balasch J, Fabregues F, Creus M, Vanrell JA: The usefulness of endometrial biopsy for luteal phase evaluation in infertility. Hum Reprod 1992;7: 973–977.PubMedGoogle Scholar
  33. 33.
    Scott RT, Snyder RR, Strickland DM, Tyburski CC, Bagnall JA, et al: The effect of interobserver variation in dating endometrial histology on the diagnosis of luteal phase defects. Fertil Steril 1988;50:888–892.PubMedGoogle Scholar
  34. 34.
    Downs KA, Gibson M: Basal body, temperature graph and the luteal phase defect. Fertil Steril 1983;40:466–468.PubMedGoogle Scholar
  35. 35.
    Dallenbach-Hellweg G: The endometrium of infertility. A review. Path Res Pract 1984; 178:527–537.PubMedCrossRefGoogle Scholar
  36. 36.
    Good RG, Moyer DL: Estrogen-progesterone relationships in the development of secretory endometrium. Fertil Steril 1968;19:37–45.PubMedGoogle Scholar
  37. 37.
    GillamJS: Study of the inadequate secretion phase endometrium. Fertil Steril 1955;6:18–36.Google Scholar
  38. 38.
    Noyes RW: The underdeveloped secretory endometrium. Am J Obstet Gynecol 1959;77:929–945.PubMedGoogle Scholar
  39. 39.
    Noyes RW, Haman O: The accuracy of endometrical dating. Fertil Steril 1953;4:504–517.PubMedGoogle Scholar
  40. 40.
    Li T-C, Dockery P, Rogers AW, Cooke ID: How precise is histologic dating of endometrium using the standard dating criteria? Fertil Steril 1989;51: 759–763.PubMedGoogle Scholar
  41. 41.
    Li TC, Rogers AW, Dockery P, Lenton EA, Gooke ID: A new method of histologic dating of human endometrium in the luteal phase. Fertil Steril 1988;50:52–60.PubMedGoogle Scholar
  42. 42.
    Graham RA, Seif MW, Aplin JD, Li TG, Cooke ID, et al: An endometrial factor in unexplained infertility. Br Med J 1990;300:1428–1431.CrossRefGoogle Scholar
  43. 43.
    Seif MW, Aplin JD, Buckley GH: Luteal phase defect: The possibility of an immunohistochemical diagnosis. Fertil Steril 1989;51:273–279.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1995

Authors and Affiliations

  • Michael T. Mazur
    • 1
  • Robert J. Kurman
    • 2
    • 3
  1. 1.Crouse Irving Memorial Hospital, Health Science CenterState University of New YorkSyracuseUSA
  2. 2.Departments of Gynecology and Obstetrics and PathologyThe Johns Hopkins HospitalBaltimoreUSA
  3. 3.The Johns Hopkins University School of MedicineBaltimoreUSA

Personalised recommendations