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• W2041061681 abstract "Objective: We have developed an endometrial function test (EFT) where an abnormal EFT is associated with pregnancy failure (lack of implantation or early loss) while a normal EFT is associated with pregnancy success. We examined the impact the EFT had on ART care in several infertility practices.Design: Immunohistochemical testing of endometrial biopsies was correlated with clinical outcomes.Materials/Methods: Endometrial biopsies were collected during the previous two years from 195 patients on cycle days 15 and 24 or only cycle day 24 from natural and mock cycles. Natural cycle biopsies were timed with the LH surge (set as cycle day 13) while mock cycles were timed by P start date (set as cycle day 14). The EFT consisted of immunohistochemistry utilizing antibodies against progesterone receptor, mouse ascites Golgi mucin (MAG), cyclin E, and p27. Each biopsy was graded as normal or abnormal compared to the results obtained from fertile controls. Followup data were collected every 6 months after the initial EFT.Results: EFTs were performed on 195 patients with one or more previous ART failures. 50 patients (26%) were normal while 145 (74%) were abnormal. Of the patients with normal EFTs, 15 of 29 with subsequent ART procedures became pregnant (52%), of which 10 (34%) carried to term. Of the 145 patients with initial abnormal EFTs, 37 had some form of intervention prior to their next embryo transfer. Of these, 12 subsequent EFTs were either normal or significantly improved (39%). Of the patients with an improved second EFT where a subsequent ART procedure was performed (n = 7), 5 became pregnant (71%). 6 patients with an intervention did not have a followup EFT. 5 (83%) of these patients had an ongoing pregnancy. Of the 17 patients with an initial abnormal EFT who did not have any form of intervention, 7 (41%) became pregnant, but only 2 (12%) carried past the 1st trimester. Patients with subsequent embryo transfers who were normal or had an intervention (n = 45) had 23 ongoing pregnancies (51%). Patients who were abnormal without intervention (n = 22) had 2 ongoing pregnancies (9%). 2-way contingency table analysis revealed that a patient with an abnormal EFT who had no form of intervention was 10.5 times less likely to have an ongoing pregnancy (OR = 10.5, 95% CI: 1.29 - 680; PPV = 91%, 95% CI: 72 - 100%; p <0.001 (Fisher Exact Test)) than a patient who had a normal EFT or had an intervention following an abnormal EFT.Conclusions: When the EFT resulted in altered clinical practice by the physicians who participated in this study, pregnancy rates increased. Patients with normal EFTs immediately underwent an ART cycle while patients with abnormal EFTs either underwent medical or surgical intervention or had their stimulation protocols adjusted. These interventions yielded an overall 80% pregnancy rate in a group of patients with a previously high ART failure rate.Supported by: No external support. Objective: We have developed an endometrial function test (EFT) where an abnormal EFT is associated with pregnancy failure (lack of implantation or early loss) while a normal EFT is associated with pregnancy success. We examined the impact the EFT had on ART care in several infertility practices. Design: Immunohistochemical testing of endometrial biopsies was correlated with clinical outcomes. Materials/Methods: Endometrial biopsies were collected during the previous two years from 195 patients on cycle days 15 and 24 or only cycle day 24 from natural and mock cycles. Natural cycle biopsies were timed with the LH surge (set as cycle day 13) while mock cycles were timed by P start date (set as cycle day 14). The EFT consisted of immunohistochemistry utilizing antibodies against progesterone receptor, mouse ascites Golgi mucin (MAG), cyclin E, and p27. Each biopsy was graded as normal or abnormal compared to the results obtained from fertile controls. Followup data were collected every 6 months after the initial EFT. Results: EFTs were performed on 195 patients with one or more previous ART failures. 50 patients (26%) were normal while 145 (74%) were abnormal. Of the patients with normal EFTs, 15 of 29 with subsequent ART procedures became pregnant (52%), of which 10 (34%) carried to term. Of the 145 patients with initial abnormal EFTs, 37 had some form of intervention prior to their next embryo transfer. Of these, 12 subsequent EFTs were either normal or significantly improved (39%). Of the patients with an improved second EFT where a subsequent ART procedure was performed (n = 7), 5 became pregnant (71%). 6 patients with an intervention did not have a followup EFT. 5 (83%) of these patients had an ongoing pregnancy. Of the 17 patients with an initial abnormal EFT who did not have any form of intervention, 7 (41%) became pregnant, but only 2 (12%) carried past the 1st trimester. Patients with subsequent embryo transfers who were normal or had an intervention (n = 45) had 23 ongoing pregnancies (51%). Patients who were abnormal without intervention (n = 22) had 2 ongoing pregnancies (9%). 2-way contingency table analysis revealed that a patient with an abnormal EFT who had no form of intervention was 10.5 times less likely to have an ongoing pregnancy (OR = 10.5, 95% CI: 1.29 - 680; PPV = 91%, 95% CI: 72 - 100%; p <0.001 (Fisher Exact Test)) than a patient who had a normal EFT or had an intervention following an abnormal EFT. Conclusions: When the EFT resulted in altered clinical practice by the physicians who participated in this study, pregnancy rates increased. Patients with normal EFTs immediately underwent an ART cycle while patients with abnormal EFTs either underwent medical or surgical intervention or had their stimulation protocols adjusted. These interventions yielded an overall 80% pregnancy rate in a group of patients with a previously high ART failure rate. Supported by: No external support." @default.
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• W2041061681 title "The endometrial function test (EFT) directs care and predicts ART outcome" @default.
• W2041061681 doi "https://doi.org/10.1016/s0015-0282(02)03424-6" @default.
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