Safer Care Victoria’s Best Care resources support patients and healthcare providers to have conversations and make decisions together about the most appropriate pathways for care.
This resource, developed for clinicians, details a specific elective surgery procedure that should now only be done for specific indications. Evidence-based recommendations that detail ‘best care’ pathways should be discussed with your patient to determine the most appropriate pathway of care.
Advice
An endometrial biopsy contributes minimal clinical benefit in guiding management of most cases of infertility.
Endometrial biopsy should not be offered to evaluate the luteal phase as part of investigating fertility problems because there is no evidence that medical treatment of luteal phase defect improves pregnancy rates.
When is the procedure indicated?
Endometrial biopsy or hysteroscopy dilatation and curettage may be indicated if concurrent endometrial pathology needs exclusion.
Best care recommendations
Infertility investigations should include the following in the specified order:
- a full history and physical examination
- specific tests including a basic hormonal evaluation (completed during the follicular phase of the cycle)
- evaluation of pelvic organ anatomy (for example, via hysterosalpingography) and a semen analysis.
Further testing may be indicated on a case-by-case basis; however, the above examinations should provide clarity in most infertility causes.
Evidence
American College of Obstetricians and Gynecologists. Infertility workup for the women’s health specialist. ACOG Committee Opinion No. 781. Washington, DC: Obstetrics & Gynecology 2019;133:e377–84.
Choussein S, Vlahos NF. Female Fertility Assessment. Current Obstetrics and Gynecology Reports. 2012 Dec 1;1(4):174-81.
Coutifaris C, Myers ER, Guzick DS, Diamond MP, Carson SA, Legro RS, et al. Histological dating of timed endometrial biopsy tissue is not related to fertility status. Fertility and Sterility. 2004 Nov 1;82(5):1264-72.
National Institute for Health and Care Excellence. Fertility problems: assessment and treatment. London (UK): National Institute for Health and Care Excellence; 2016 [cited 2020 Aug 12].