The authors declare that they have no competing interests.
Zhao J carried out the acquisition of data, analysis and interpretation of data and writing of the manuscript. Zhang Q has been involved in the ultrasound examination and in revising the manuscript. Li YP conceived of the study, participated in its design and coordination, and helped to draft the manuscript. All authors have read and approved the final version of the manuscript.
To study the effect of endometrial thickness and pattern measured using ultrasound upon pregnancy outcomes in patients undergoing IVF-ET.
One thousand nine hundred thirty-three women undergoing IVF treatment participated in the study. We assessed and recorded endometrial patterns and thickness on the day of human chorionic gonadotropin (hCG) administration. Receiver operator curves (ROC) were used to determine the predictive accuracy of endometrial thickness. Cycles were divided into 3 groups depending on the thickness (group 1: ≤ 7 mm; group 2: > 7 mm to ≤ 14 mm; group 3: > 14 mm). Each group was subdivided into three groups according to the endometrial pattern as follows: pattern A (a triple-line pattern consisting of a central hyperechoic line surround by two hypoechoic layers); pattern B (an intermediate isoechogenic pattern with the same reflectivity as the surrounding myometrium and a poorly defined central echogenic line); and pattern C (homogenous, hyperechogenic endometrium). Clinical outcomes such as implantation and clinical pregnancy rates were analyzed.
The endometrial thickness predicts pregnancy outcome with high sensitivity and specificity. The cutoff value was 9 mm. The implantation rate and clinical pregnancy rate in group 3 were 39.1% and 63.5%, respectively, which were significantly higher than those in group 2 (33.8% and 52.1%, respectively) and group 1 (13% and 25.5%, respectively). Among those with Pattern A, the implantation rate and clinical pregnancy rate were 35.3% and 55.2%, respectively, which were significantly higher than among women with Pattern B (32.1% and 50.9%, respectively) and Pattern C (23.4% and 37.4%, respectively). In groups 1 and 3, clinical pregnancy and implantation rates did not show any significant differences between different endometrial patterns (P > 0.05), whereas in group 2, the clinical pregnancy rate and implantation rate in women with pattern A were significantly higher than those with pattern B or C (P < 0.05).
Endometrial thickness and pattern independently affect pregnant outcomes. Combined endometrial thickness and pattern could not predict the outcome of IVF-ET when endometrial thickness was < 7 mm or >14 mm, while a triple-line pattern with a moderate endometrial thickness appeared to be associated with a good clinical outcome.
Gonen Y, Casper RF, Jacobson W, Blankier J: Endometrial thickness and growth during ovarian stimulation: A possible predictor of implantation in in vitro fertilization. Fertil Steril. 1989, 52: 446-450. PubMed
Gonen Y, Casper RF: Prediction of implantation by the sonographic appearance of the endometrium during controlled ovarian stimulation for in vitro fertilization (IVF). J in Vitro Fert Embryo Transfer. 1990, 7: 146-152. 10.1007/BF01135678. CrossRef
Schild RL, Knobloch C, Dorn C, Fimmers R, Van der Ven H, Hansmann M: Endometrial receptivity in an in vitro fertilization program as assessed by spiral artery blood flow, endometrial thickness, endometrial volume, and uterine artery blood flow. Fertil Steril. 2001, 75: 361-366. 10.1016/S0015-0282(00)01695-2. CrossRefPubMed
Dietterich C, Check JH, Choe JK, Nazari A, Lurie D: Increased endometrial thickness on the day of human chorionic gonadotropin injection does not adversely affect pregnancy or implantation rates following in vitro fertilization-embryo transfer. Fertil Steril. 2002, 77: 781-786. 10.1016/S0015-0282(01)03276-9. CrossRefPubMed
Detti L, Yelian FD, Kruger ML, Diamond MP, Rode A, Mitwally MFM: Endometrial thickness is related to miscarriage rate, but not the estradiol concentration, in cycles down-regulated with gonadotropin-releasing hormone antagonist. Fertil Steril. 2008, 89: 998-1001. 10.1016/j.fertnstert.2007.04.027. CrossRefPubMed
Ai-Ghamdi A, Coskun S, AL-Rejjal R, Awartani K: The correlation between endometrial thickness and outcome of in vitro fertilization and embryo transfer (IVF-ET) outcome. Reprod Biol Endocrinol. 2008, 6: 37-10.1186/1477-7827-6-37. CrossRef
Check JH, Lurie D, Dietterich C, Callan C, Baker A: Adverse effect of a homogeneous hyperechogenic endometrial sonographic pattern, despite adequate endometrial thickness on pregnancy rates following in-vitro fertilization. Hum Reprod. 1993, 8: 1293-1296. PubMed
Gonen Y, Calderon I, Dirnfeld M, Abramovici H: The impact of sonographic assessment of the endometrium and meticulous hormonal monitoring during natural cycles in patients with failed donor artificial insemination. Ultrasound Obstet Gynecol. 1991, 1: 122-126. 10.1046/j.1469-0705.1991.01020122.x. CrossRefPubMed
Nahari CP, Catherno WH, Mckeeby JL, Wesley R, Segars JH: A suboptimal endometrial pattern is associated with a reduced likelihood of pregnancy after a day 5 embryo transfer. Fertil Steril. 2005, 83: 235-237. 10.1016/j.fertnstert.2004.05.102. CrossRef
Detti L, Saed GM, Fletcher NM, Kruger M, Brossoit M, Diamond MP: Endometrial morphology and modulation of hormone receptors during ovarian stimulation for assisted reproductive technology cycles. Fertil Steril. 2011, 95: 1073-1081. 10.1016/j.fertnstert.2010.12.027. CrossRef
- The effect of endometrial thickness and pattern measured by ultrasonography on pregnancy outcomes during IVF-ET cycles
- BioMed Central
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