Objective. To find the relation between the endometrial sonographic parameters and the success of ICSI in normal responders. Material and Methods.A prospective cohort study was performed from September 2020 to March 2022 including 262 women normal responder women undergoing an ICSI cycle. Endometrial thickness (ET), endometrial pattern, and sub-endometrial blood flow were measured on the day of HCG. According to ET, the patients were classified into 3 groups: < 8 mm, 8-12 mm, and > 12 mm, according to endometrial pattern into a triple and non-triple line, as well as according to endo-sub endometrial blood flow into the zone I, zone II and zone III. Pregnancy rates were compared between all groups.Results. The overall pregnancy rate among all groups was 43.12%. The clinical pregnancy rate was significantly lower with ET below 7 mm; but, increased in the group with ET 8-12 mm 86/113 (76.1%), lower in the group with ET > 12 mm 25/113 (22.1%), and lowest when ET < 8 mm 2/113 (1.8%). The pregnancy rate in the triple endometrial pattern 70/113 M a n u s c r i p t a c c e p t e d f o r p u b l i c a t i o n (61.9%) is higher than in the non-triple pattern 43/113 (38.1%). However, the endo-sub endometrial blood flow did not affect the pregnancy rate significantly (P-value = 0.435). Conclusions.Endometrial thickness exhibits a curvilinear relationship with pregnancy outcomes in fresh embryo transfer cycles. A triple ET 8 mm thickness or more, could be a reliable predictor for successful pregnancy outcomes in fresh ICSI cycles. Yet, ET (≤ 7 mm) and no triple-line endometrial pattern coexist in an ICSI candidate, cryopreservation should be recommended.
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