Hysteroscopic appearance of the mid-secretory endometrium: relationship to early phase pregnancy outcome after implantation.

A total of 172 patients who underwent hysteroscopic assessment of the endometrium and then became pregnant, was analysed retrospectively to explore the relationship between endoscopic findings and early phase pregnancy outcome after implantation. Histological examination of the endometrium and assay of serum progesterone and oestrogen were carried out simultaneously with hysteroscopy. Of 172 patients, 12 were excluded. Of the remaining 160 patients, 62 (38.8%) were classified endoscopically as having 'good' mid-secretory endometrium and 98 (61.3%) as 'poor', between one and four cycles prior to the conception cycle. There were no clinical differences between these two groups, except that the frequency of patients with a history of early abortion was significantly higher in the 'poor' group (25.5%) than in the 'good' group (8.1%) (P < 0.05). Of 160 pregnancies, 118 persisted successfully to live birth, but 42 ended in early pregnancy loss. The incidence of early abortion was significantly higher in the 'poor' group (33.7%) than in the 'good' group (14.5%) (P < 0.05). Significant differences were observed between the two groups for histological dating of the endometrium (P < 0.05) but not for serum progesterone and oestradiol concentrations or progesterone:oestradiol ratio. In conclusion, our data suggest that the hysteroscopic appearance of the mid-secretory endometrium at this stage of the menstrual cycle is a better prognostic factor for pregnancy outcome than hormonal data.