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The endometrium is typically biopsied because of abnormal bleeding.

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In any case, one should not average cycle days and report ’POD 3 or 17th-day secretory endometrium’.To ensure a maximum amount of tissue for morphological reading, the specimen should be placed on a piece of lens paper or some other adhesive tissue and then immersed in the fixative.By this means, all of the tissue fragments remain tightly attached to the lens paper, rather than floating in the fixative, and no tissue will be lost for histologic examination.In contrast, secretory-phase endometrium often demonstrates subtle changes and, in many cases, combinations of morphologic changes, resulting in most instances in errors of 4–5 days.The pathologist can improve this to 2–3 days, however, by acquiring expertise in endometrial dating (all cases of normal endometria are to be dated regardless of reasons for sampling), and by basing the dating on those endometrial morphologic alterations that represent the most advanced phase of the menstrual cycle.The continued use of the endometrial biopsy for the diagnosis of luteal phase defects (LPDs) and in the general evaluation of the infertile couple is based largely on tradition, the absence of a clearly superior diagnostic modality, the absence of studies that have either validated or repudiated its efficacy with certainty, its ability to assess the endometrial response irrespective of endogenous progesterone levels, its ability to monitor the endometrial response to hormonal therapy in fertility treatments, and, finally, its ability to exclude other intrinsic endometrial anomalies that may be detrimental to the implantation of the conceptus, such as chronic endometritis or neoplasia.

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