UTERINE GLANDULAR AREA DURING THE MENSTRUAL-CYCLE AND THE EFFECTS OF DIFFERENT IN-VITRO FERTILIZATION RELATED HORMONAL TREATMENTS

The human uterine glandular epithelium undergoes a sequence of well ch aracterized changes during the menstrual cycle that presumably play an important role in preparation for blastocyst implantation, The aim of this study was to measure objectively glandular volume over the entir e menstrual cycle and compare the results with eight different clinica l superovulation or hormone replacement therapy (HRT) subject groups. Endometrial biopsies were taken from control normal menstrual cycle su bjects (n = 96), and eight other smaller groups of women who had recei ved different in-vitro fertilization (IVF) related treatments. The tot al area of glandular epithelium was objectively measured from routine histological slides using computerized image analysis. Control menstru al cycle results showed a significantly greater gland area in the earl y secretory stage of the cycle than at any time between the early prol iferative through to the mid-late proliferative stages (P < 0.05). IVF patients receiving clomiphene citrate and human menopausal gonadotrop hin had a significantly smaller glandular area than those in the contr ol groups at equivalent stages of the menstrual cycle. The use of prog esterone supplementation removed this significant difference. Patients on the 'Flare' regime had the highest gland area, although this was n ot significantly different from controls. Buserelin down-regulation ga ve a gland area that was closest to the normal cycle controls. The thr ee HRT groups showed high variability in gland volume between patients . The results from this study demonstrate that superovulation can caus e significant alterations in endometrial gland volume, but that these do not necessarily preclude implantation.