Journal of Krishna Institute of Medical Sciences University (Jul 2022)
Histopathological study of endometrial biopsy in infertility: A cross sectional study in a teaching hospital
Abstract
Background: Endometrium is dynamic tissue which responds to hormones hence is the most sensitive indicator of ovarian function. Uterine pathology and cervical pathology like chronic infections or quality of cervical mucus plays a role in failure of conception. Hence endometrial biopsy is one of the most important investigations in infertility. Aim and Objectives: To document the morphological changes seen in endometrial biopsies and their demographic distribution in patients with infertility. Secondly to examine cervico-vaginal pap smear changes in infertility cases. Material and Methods: The study is a prospective cross-sectional study carried out during the period of June 2018 to July 2020. Married women visiting infertility clinic, who have undergone endometrial biopsy as an infertility evaluation were included in the study. Informed consent for the procedure was taken. Only premenstrual endometrial biopsy was included and inadequate biopsy samples were excluded from the study. Cervico-vaginal pap smear of these cases was processed under liquid-based cytology and reported using Bethesda system for cervical cytology. The histopathological findings and pap smear findings were statistically analyzed. Results: Ten percent of endometrial biopsies were indicated in evaluation of infertility among all biopsy registries. Primary infertility accounted 64% and secondary infertility as 36%. Sixty-six cases of endometrial biopsy were studied during study period. The most common histopathological findings were secretory endometrium, followed by proliferative (anovulatory and 2 cases luteal phase defect) endometrium, progestin induced changes, endometrial polyps, chronic endometritis and benign hyperplasia. Seventy-seven percentage of pap smears were negative for intraepithelial lesions (no squamous or endocervical abnormalities), predominantly showing signs of cervicitis and bacterial vaginitis. Conclusion: Histopathological study of endometrium forms an important, safe and cheaper diagnostic tool. Uterine pathology contributes to major pathogenesis of infertility and thus endometrial biopsy plays a significant role in preliminary evaluation of cases with infertility.
