SUPEROVULATION WITH HUMAN MENOPAUSAL GONADOTROPINS IS ASSOCIATED WITHENDOMETRIAL GLAND-STROMA DYSSYNCHRONY

Objective: To investigate the prevalence of endometrial inadequacy in endometrial biopsies from women undergoing superovulation with hMG and to correlate these findings with the hormonal milieu. Design: Control led, retrospective analysis. Setting: University-based, tertiary refer ral, outpatient infertility clinic. Subjects: Endometrial biopsies wer e performed during the late luteal phase in 89 women undergoing hMG su perovulation combined with IUI. Results were compared with the initial biopsies obtained as part of their routine infertility evaluation. Ma in Outcome Measures: Biopsies were dated by two different observers us ing standard dating criteria. Serum samples obtained during the midlut eal phase were assayed in duplicate for E(2) and P levels using commer cially available RIAs.Results: Fifty-seven percent of the endometrial biopsies showed differences in the dating of the glandular epithelium that differed by >2 days when compared with the stroma. In contrast, o nly 13% of endometrial biopsies obtained during a nonstimulated cycle showed gland-stroma dyssynchrony. When cycles associated with gland-st roma dyssynchrony were compared with cycles associated with coordinate d development of the glands and stroma, no significant differences wer e observed in E(2) level on the day of hCG administration, midluteal s erum P, midluteal E(2) level, or P:E(2) ratios. Conclusions: This stud y demonstrates that when endometrial biopsies are obtained during the late luteal phase in patients undergoing ovarian hyperstimulation ther e is a significant dyssynchrony in the maturation of the glandular epi thelium and the stroma. This may reflect the degree of responsiveness of an individual woman's endometrium rather than a result of the hormo nal milieu.