The Clinical Usefulness of Endometrial Biopsy for the Diagnosis of Endometriosis in the Work up of Women with Infertility

Background & Aims: The eutopic endometrium in women with endometriosis harbor small nerve fibres. This study aimed to explore the clinical usefulness of office endometrial biopsy to detect endometrial nerve fibres as diagnostic test for endometriosis in the work up of women with infertility and no endometrioma. Material & Methods: A cohort of 28 Jordanian women with infertility and without endometriomas was prospectively followed up for 1 year. All women underwent clinical evaluation and an office endometrial biopsy. Those with positive nerve fibres using immunohistochemistry with PGP9.5 were considered endometriosis patients and underwent planned laparoscopy while those with negative results were considered endometriosis free and underwent assisted reproductive techniques. All patients were followed up at 3, 6 and 12 months. Results: Eighteen women had positive nerve fibres and underwent planned laparoscopy. At laparoscopy 14 patients had endometriosis, two cases had no visible endometriosis (sensitivity 88.9 (16/18). In women with endometriosis and pain symptoms (n- 12) the density of nerve fibres was higher than in those with endometriosis and no pain symptoms (n-6) 2.1 and 0.6 per mm2 respectively (P = 0.005). Women with negative results at biopsy (n-10) underwent either ovulation induction or IVF. In both groups at one year follow up the pregnancy rate was similar (60%). Conclusions: The proposed method may be useful in the work up of patients with infertility and without endometrioma and would allow gynecologists to triage infertility patients and plan for a potentially valuable laparoscopy and will also shorten the delay of endometriosis diagnosis.