EVALUATING THE EFFECT OF AGE ON ENDOMETRIAL RESPONSIVENESS TO HORMONEREPLACEMENT THERAPY - A HISTOLOGIC ULTRASONOGRAPHIC, AND TISSUE RECEPTOR ANALYSIS

Objective: Our objective was to characterize the endometria of women o f various ages placed on similar estrogen/progesterone replacement reg imens prior to attempted donor embryo transfer using histologic, ultra sonographic, and steroid receptor markers in order to determine if adv ancing age has a detrimental effect on uterine responsiveness to pharm acologic sex steroid replacement therapy. Study Design: This was a pro spective open clinical trial. Functionally agonadal women aged 25 to 6 0 years receiving hormone replacement therapy underwent transvaginal u ltrasound examination of the uterus followed by a timed endometrial bi opsy on artificial cycle day 21. Endometrial histology and estrogen an d progesterone receptors were analyzed from biopsy material. Subjects were assigned to three groups according to age: Group I, aged 25 to 39 years (n = 48); Group II, aged 40 to 49 years (n = 61); and Group III , aged 50 to 60 years (n = 13). Endometrial preparation was accomplish ed in all patients using the same sequential regimen consisting of ora l micronized estradiol and intramuscular progesterone. Results: Simila r histologic, ultrasonographic, and steroid receptor characteristics w ere noted in all groups of patients regardless of age. A normal appear ing midluteal secretory endometrium was demonstrated histologically in 85% of biopsies. However, 15% of biopsies exhibited intraluminal papi llary excrescences within the glands and/or an increase in the normal gland-to-stroma ratio. Three patients, one from each group, did not in itially respond to replacement therapy and required further treatment. Conclusion: Functionally agonadal women exhibit normal or near-normal endometrial responses to sex steroid replacement therapy designed to imitate the natural cycle through the sixth decade of life.