Smita is a case of infeility. What is the right time in her menstrual cycle to do endometrial biopsy.
Ans. is c i.e. 20 - 22 days ENDOMETRIAL BIOPSY OPD procedure for hormonal evaluation in case of infeility / DUB/TB. Usually performed in pre - menstrual phase from lateral wall of vagina. Interpretation : Presence of secretory endometrium Progesterone phase (cycles has been ovulatory) Presence of proliferative endometrium Anovulatory cycle Luteal phase defect can also be diagnosed by endometrial biopsy (which shows a lag of 2 - 3 days between calendar and histological dating of specimen). Endometrial biopsy is contraindicated in suspected malignancy / sepsis. 130 Test Time Observation TESTS FOR DOCUMENTING OVULATION Basal Body Temp Cervical mucus Vaginal cytology Endometrial Biopsy Serum Progesterone Follicular Monitoring Laparoscopy Through out cycle Day 12 - 14 Day 21 - 23 Day 12 - 14 Day 21 - 23 Premenstrual phaseD8 and D21 D10 - D14 Secretory phase Biphasic pattern Cervical mucus is clear watery, stretchability present, ferning present. Cervical mucus is thick, viscid, tack present ferning absent. Estrogen dominated smears - clear. discrete corn-fined, polygonal, superficial cells (predominant cells) Progesterone dominated smear -containing diy, predominantly intermediate (Navicular) cells. Secretory Endometrium (Confirming ovulation) D - 8 < 1 ng/ml D - 21 > 6.5 ng/m1 Follicle is measured by USG. Recent corpus luteum is directly seen PAT TESTS FOR TUBAL ENCY : (Or for any Tubal Pathology) : viz Insufflation test HSG Sono hystero salpingography Fallopscopy (Mid follicular phase) Day 6 - Day 11 (not performed later so that if pregnancy has occurred & zygote formed it is not disrupted & not earlier when the patient is menstruating as retrograde menstruation can cause endometriosis) TEST FOR CERVICAL FACTOR : viz Post coital test Immunological tests Done just before ovulation (as cervical mucus is most Miller kurzrok test receptive for sperm at that time). Also know : Any radiological investigation in a young / reproductive age woman should be done between Day 1 to Day 10 of cycle. Endometrial Biopsy for diagnosis of T:B should be done in late premenstrual phasedeg as tubercles are present in superficial layer and shed during menstruation. The tissue obtained is subjected to polymerase chain reaction test instead of culture.
12 - l4 days
17 - 19 days
20 - 22 days
3-5days