For Providers

Dear Fellow Physician,

Thank you for your interest in the Endometrial Function Test® (EFT®), a service of the Reproductive and Placental Research Unit at the Yale University School of Medicine. Here you will find an EFT® Biopsy Protocol form with directions for our preferred collection procedures, fixation protocol, and shipping instructions. Also, please find a Request for EFT® form which should be filled out and sent along with each biopsy.

Due to HIPAA regulations, we also ask that your patient complete our EFT® HIPAA Patient Consent Form and include it with the first biopsy you send us for each patient. Unfortunately, we cannot perform the EFT unless we receive a signed HIPAA form.

Please be aware that specimens can only be received Monday through Friday. It generally will take a few days to have the tissue embedded and sectioned to have unstained slides prepared for immunohistochemistry. It is best to send biopsies in the beginning of the week to ensure that they will be included in the following week’s staining. However, please adhere to the guidelines concerning appropriate cycle days for biopsy whenever possible. These guidelines can be found in the EFT® Biopsy Protocol. We would prefer a specimen stay in fixative for a few days longer than have it collected at an inappropriate time of the cycle. You can batch mail biopsies from different patients if that is convenient for you. After we review the slides, we will generate a report, which will be emailed, mailed or faxed to the addresses you specify in the Request for EFT® form.

An overview of the EFT, and the key markers behind it, can be found in our July 2003 article Improved Endometrial Assessment Using Cyclin E and p27, Fertility and Sterility, 80: 146-56, 2003. You can also find additional information on our markers in the Infertility section. As part of our review, we evaluate every specimen for:

• Endometrial hyperplasia
• Endometrial cancer
• Chronic endometritis
• Acute endometritis
• Persistent implantation site trophoblasts or retained products of conception
• Placental site trophoblast tumor
• Parasitic or viral infections

It is important for you to know that dissolving, homogenizing, or digesting an endometrial biopsy solely for molecular testing cannot diagnose these conditions, nor make any recommendations related to the additional conditions listed below.

In addition to histologic dating, marker results, and photomicrographs of control images and the specific results from your patient’s testing, our reports, when appropriate, make additional comments on the following:

I will be happy to discuss with you our current understanding of the significance of the results generated by any particular biopsy that you send us. I can be reached by email at: harvey.kliman@yale.edu.

If you would like us to send you additional patient oriented articles, brochures, FedEx Airbills, or shipping tubes, please contact Kristin Milano at 203-785-7642, by email (kristin.milano@yale.edu), or use our convenient online supplies request form at: EFT Supplies.

Our routine protocol is to examine an H&E stained slide for standard dating and to evaluate each biopsy with a panel of markers. On cycle day 15 we routinely evaluate progesterone receptor (PR) and cyclins, while on cycle day 24 we evaluate cyclins only. Under certain circumstances, if the patient is known to be blood group A or AB, we may also examine MAG (mouse ascites golgi mucin epitope).

We require a payment of $595 to be sent with each biopsy in the form of a money order or cashier’s check made payable to Yale University. We also now accept credit card payments from MasterCard and Visa (see Request for EFT® form).

If you are concerned about the amount of tissue collected at the time of biopsy, please check the H&E ($50) to rule out Quantity Not Sufficient check box. We will process the tissue and only examine the HE slide. If there is enough tissue to perform a full EFT, we will do so and charge the patient the remaining $545 with their supplied credit card. If the specimen is inadequate we will not perform the EFT and the patient will not be charged anything beyond the initial $50.

Please see the EFT® Biopsy Protocol form for details concerning our recommended protocols for frequency and timing of endometrial biopsies for performance of our Endometrial Function Test® (EFT®). Shipping costs are the responsibility of the submitting physician or patient. We will be happy to send you preaddressed FedEx Airbills.

Thank you in advance for allowing us to examine your patient’s endometrial biopsy. We look forward to working with you and your patients.