A transformation of the lining of the uterus (the endometrium) in pregnancy. Complete confluence of endometrial stromal cells (lying between the endometrial glands) occurs, caused by prolonged (14 days or more) exposure to progesterone or a progestogen; normally happens only with pregnancy.

A partial confluence of stromal cells of the endometrium (lying between the endometrial glands), caused by prolonged exposure (10 days or more) to progesterone or a progestogen.

Plump endometrial stromal cells, lying between the glands of the endometrium, formed under the prolonged influence of progesterone, especially with establishment of pregnancy. Constitutes the decidual reaction to form the decidua of pregnancy, and produce prolactin (important for regulating water entering the gestational sac) and relaxin, which keeps the myometrium quiet.

Loose connecting-type ('connective') tissue that lies between glands of the endometrium. Contains stromal cells that eventually respond to progesterone by becoming plump to form a more or less continuous sheet towards the end of the menstrual cycle (the predecidual reaction) or, more completely, with successful implantation and pregnancy (the decidual reaction).

A small sample (or biopsy) is taken of the lining of the uterus (the endometrium) just before a period is expected, aiming to show advanced stages of progesterone's effect on it, in the form of an adequate predecidual reaction. This a very sensitive test of the adequacy of the luteal phase. The biopsy can be combined with a laparoscopy or carried out in isolation as an office procedure. It's best to be sure that there is no possibility of pregnancy during the cycle the test is conducted, as occasionally the biopsy jeopardises an early pregnancy (namely an early implantation, before the pregnancy test or serum hCG has become positive).