Choosing Wisely:

Don’t perform endometrial biopsy in the routine evaluation of infertility.

Rationale and Comments: Endometrial biopsy performed for histologic dating does not distinguish fertile from infertile women. Chronic endometritis on endometrial biopsy does not predict the likelihood of pregnancy in general nor is it associated with live birth rates in assisted reproductive technology cycles. Endometrial biopsy should not be utilized in the routine evaluation of infertility.
Sponsoring Organizations:
  • American Society for Reproductive Medicine
  • Sources:
  • Expert consensus
  • Disciplines:
  • Gynecologic
  • References: • Coutifaris C, Myers ER, Guzick DS, Diamond MP, Carson SA, Legro RS, et al; NICHD National Cooperative Reproductive Medicine Network. Histological dating of timed endometrial biopsy tissue is not related to fertility status. Fertil Steril 2004 Nov;82(5):1264-72.
    • Murray MJ, Meyer WR, Zaino RJ, Lessey BA, Novotny DB, Ireland K, Zeng D, Fritz MA. A critical analysis of the accuracy, reproducibility, and clinical utility of histologic endometrial dating in fertile women. Fertil Steril. 2004 May;81(5):1333–43.
    • Batista MC, Cartledge TP, Merino MJ, Axiotis C, Platia MP, Merriam GR, Loriaux DL, Nieman LK. Midluteal phase endometrial biopsy does not accurately predict luteal function. Fertil Steril. 1993 Feb;59(2):294–300.
    • Gibson M. Clinical evaluation of luteal function. Semin Reprod Endocrinol. 1990;8:130–41.
    • Dockery P, Li TC, Rogers AW, Cooke ID, Lenton EA, Warren MA. An examination of the variation in timed endometrial biopsies. Hum Reprod. 1988 Aug;3(6):715–20.
    • Kasius JC, Fatemi HM, Bourgain C, Sie-Go DM, Eijkemans RJ, Fauser BC, Devroey P, Broekmans FJ. The impact of chronic endometritis on reproductive outcome.Fertil Steril. 2011 Dec;96(6):1451–6.
    • Haggerty C, Ness RB, Amortegui A, Hendrix SL, Hillier SL, Holley RL, Peipert J, Randall H, Sondheimer SJ, Soper DE, Sweet RL, Trucco G. Endometritis does not predict reproductive morbidity after pelvic inflammatory disease. Am J Obstet Gynecol. 2003 Jan;188(1):141–8.

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