Assessment of the late proliferative phase endometrium by ultrasonography in patients undergoing in-vitro fertilization and embryo transfer (IVF/ET)

Abstract

This study reports on 330 women aged 29 to 45 years, who underwent 411 cycles of in-vitro fertilization and embryo transfer (IVF/ET). Vaginal sonograms were performed during the late proliferative phase of natural cycles and cycles of controlled ovarian hyperstimulation (COH) with gonadotrophins, to evaluate both the thickness and echogenicity of the endometrium. Findings classified as Grade I; characterized by homogeneous echogenicity of the endometrium, and Grade II; characterized by an outer peripheral layer of dense echogenicity surrounding a central sonolucent area (i.e. a 'halo pattern'). Grades I and II were subclassified on the basis of thickness into A (greater than or equal to 9 mm) and B (less than 9 mm). Grade IIA ('optimal') was associated with a clinical pregnancy rate per embryo transfer of 33% while Grades IA, IB and IIB ('poor') were associated with a rate of only 7%. Women aged 41-45 years experienced a 25% incidence of 'poor' sonographic grades while the incidence in women less than or equal to 40 years of age was 5%. The presence of various uterine pathologies was associated with 'poor' endometrial grades in 86% of cases while only 11% of normal uteri manifested 'poor' grades. 'Optimal' endometrial grades in natural cycles were consistently associated with 'optimal' grades in ensuing cycles of COH (96%). Women with 'poor' endometrial grades in natural cycles improved in 55% of cases during subsequent COH. The results of this study indicate that sonographic assessment of the endometrial lining in the late proliferative phase during both natural and COH cycles is a valuable method for screening and managing IVF/ET candidates.

“Follicular HCG endometrium priming for IVF patients experiencing resisting thin endometrium. A proof of concept study”

“…A thin endometrium it has been reported in 5 % of women <40 years of age and in 25 % of 41-45 years old women [18] and it has also been related to poor pregnancy outcome [20]. Regarding the etiology it is considered mainly idiopathic, however, a surgical complication postcurettage might be identified in some cases [19].…”

Thin unresponsive endometrium—a possible complication of surgical curettage compromising ART outcome

“…Despite the existence of quite a few published studies, the prognostic value of ultrasonographic endometrial thickness measurements (and other parameters) in predicting implantation and pregnancy rates remains controversial. Some investigators have demonstrated a positive correlation between endometrial thickness and pregnancy rates [1][2][3][4][5][6][7][8]11] while others have not found such an association [9,10,[12][13][14], or only in association with other parameters [15,16]. However, these differences may be in part attributed to different patient populations, stimulation protocols used or measurement timing.…”

“…However, these differences may be in part attributed to different patient populations, stimulation protocols used or measurement timing. The incidence of thin endometrium in natural cycles has been reported to be 5% in women <40 years of age and 25% in 41 to 45 years old women [6]. The etiology of unresponsive endometrium and its impact on ART outcome have not been well characterized.…”

“…While some studies have shown that this parameter is important for predicting the outcome of In Vitro Fertilization (IVF) cycles [1][2][3][4][5][6][7][8], other studies have failed to show such a positive relationship [9][10][11][12][13][14]. In a third category of studies the endometrial thickness was related to the IVF outcome, but only in correlation with other parameters [15,16].…”

Relation of progesterone and luteinizing hormone serum levels and Ultrasound endometrium criteria with intracytoplasmatic sperm injection outcome

“…Our results coincided with previous researchers who showed a correlation between the endometrium pattern and IVF success. Sher et al (35) showed that the endometrial pattern has been correlated with IVF success rates, with a trilaminar pattern shown to be more favourable than a homogenous luteal pattern at the time of the human chorionic gonadotrophin administration. Singh et al (33) showed that the triple -line pattern of the endometrium was good prognostic factor for the occurrence of pregnancy.…”