Endometrial biopsy during induction of ovulation with clomiphene citrate in polycystic ovary syndrome.
BACKGROUND
The dichotomy between ovulation rates and pregnancy rates for women with polycystic ovary syndrome (PCOS) treated with clomiphene citrate (CC) prompted the present study to determine the effect of CC on endometrial maturity.


METHODS
Retrospective case-control study of anovulatory women with PCOS (n = 119) on their third ovulatory cycle of CC and controls, 238 healthy regularly ovulating women whose partners had abnormal sperm, all of whom had an endometrial biopsy in the late luteal phase.


RESULTS
Endometrial histology classified according to the classical Noyes criteria revealed out-of-phase endometrium in 19/119 (16%) of the CC group compared with 7/238 (3%) in controls (p < 0.0001). Duration of the luteal phase was not influenced by histological age of the endometrium. Endometrial biopsy performed during 138 conception cycles extracted from the database did not increase the miscarriage rate significantly (23.9%).


CONCLUSIONS
CC treatment significantly increases the prevalence of out-of-phase endometrium and this could explain, in part, the large difference between ovulation and pregnancy rates. There was no correlation between the results of the endometrial biopsy and the duration of the luteal phase. Performing an endometrial biopsy during a conception cycle does not seem to have a significant negative effect on the outcome of pregnancy.
Homburg
Roy
R
Division of Reproductive Medicine, Department of Obstetrics and Gynaecology, Vrije Universiteit Medical Center, Amsterdam, The Netherlands. R.Homburg@vumc.nl
Pap
Hannah
H
Brandes
Monique
M
Huirne
Judith
J
Hompes
Peter
P
Lambalk
Cornelius B
CB
D000328:Adult; D001706:Biopsy; D002996:Clomiphene / Q000494:pharmacology*; D004717:Endometrium / Q000187:drug effects* / Q000254:growth & development / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D010060:Ovulation / Q000187:drug effects*; D011085:Polycystic Ovary Syndrome / Q000473:pathology* / Q000601:surgery*; D011247:Pregnancy; D013997:Time Factors
D002996:Clomiphene