UTERINE AND ENDOMETRIAL REVIEW
Endometrial analysis before fertility treatment
Endometrial assessment begins with history, ultrasound and the clinical question that needs an answer. Hysteroscopy, biopsy, microbiology or receptivity-related testing should be considered selectively rather than offered as a routine package.
Question-led testing
Each study should address a finding, symptom or treatment decision.
Proportional evaluation
Not every patient needs biopsy, hysteroscopy or molecular testing.
Results in context
A result is interpreted with age, uterus, embryos and prior cycles.
POSSIBLE COMPONENTS
How the endometrium may be evaluated
The appropriate pathway depends on symptoms, ultrasound findings, prior implantation history and whether a result would change management.
Ultrasound and uterine cavity
Endometrial pattern, thickness and structural findings such as polyps, fibroids or fluid.
Hysteroscopy or biopsy
Considered when there is a specific indication, with risks and alternatives explained.
Specialized testing
Microbiome, inflammation or receptivity tests have limitations and are not universal requirements.
A STEPWISE REVIEW
From the clinical question to a decision
Define the problem
Clarify symptoms, imaging, embryo history and previous transfers.
Start with core evaluation
Review ultrasound and the uterine cavity when indicated.
Select additional tests
Order only studies that can reasonably change treatment.
Plan the next cycle
Document findings, uncertainty, treatment and reassessment.
DECISION SUPPORT
What a test cannot guarantee
No endometrial test can guarantee implantation or live birth. Embryo factors, age, uterine anatomy, laboratory conditions and biological variability still affect outcomes.
- Ask what treatment would change for each possible result.
- Confirm sample timing, laboratory method and inconclusive-result policy.
- Review cost and alternatives before repeating a test.
Important limitation: Specialized tests should not delay a more useful evaluation or be presented as a complete explanation for every failed transfer.
Request an individual endometrial review
Send prior ultrasound, hysteroscopy, biopsy and transfer reports so the team can identify which questions remain unanswered.
