Cumulative Live Birth Rate in Patients With Thin Endometrium: A Real-World Single-Center Experience

Abstract

Background: Studies have shown that patients with a thin endometrial thickness (EMT < 7 or 8 mm) during IVF/ICSI tend to have adverse pregnancy outcomes, and this has caused much anxiety to both patients and physicians when confronted with a thin EMT. Method: From January 2015 to December 2018, patients with a thin EMT < 7 mm on the day of hCG administration during their first GnRH agonist IVF/ICSI cycle were included. According to the hysteroscopy results, patients were classified into totally normal (Group A), normal with a specific abnormality (Group B), and adhesion before transfer (Group C). Result: For the 245 patients included, approximately 60% of the thin EMT cases were the result of an intrauterine operation. CLBR was 35.45% (67/189) in this group of patients. In regard to CLBR, there were significant differences among these three uterus condition groups irrespective of the number of oocytes retrieved (28.57 vs. 10.00 vs. 4.76%, P = 0.12 in oocyte ≤5; 61.36 vs. 44.67 vs. 23.63%, P = 0.00 in oocyte >5). In binary logistic regression analysis, age (OR = 0.09, P = 0.03), number of embryos available (OR = 1.71, P = 0.00), and uterine condition (OR = 6.77, P = 0.00 for group A; OR = 2.55, P = 0.04 for group B; Reference = group C), were significantly associated with CLBR. However, EMT and endometrial pattern had no impact on CLBR. Conclusion: An intrauterine operation was the main reason for a thin EMT. Thin EMT patients with a normal uterine cavity and endometrium had a significantly better CLBR compared with those with adhesions before transfer.

Hormone Replacement Therapy With GnRH Agonist Pretreatment Improves Pregnancy Outcomes in Patients With Previous Intrauterine Adhesions: a Retrospective Study

“…However, in those combined with thin endometrium, the clinical pregnancy rate was 25.62%, live birth rate was 13.30%, and early miscarriage rate was 36.54%. Our results were in line with the previous studies [4,20].…”

“…IUAs combined with thin endometrium (< 7 or 8 mm) has been demonstrated to signi cantly decrease implantation and pregnancy rate [4,33]. Guo Z and coworkers suggested that for women with a thin endometrium and were undergoing IVF, FET was associated with signi cantly higher incidences of live birth, clinical pregnancy, and biochemical pregnancy than in the fresh ET group [9].…”

“…Hysteroscopic surgery to remove IUAs followed by reproductive assistance technology is the most effective treatment to improve pregnancy prognosis. However, the reproductive outcomes in IUAs are much lower than those in general population, particularly when combined with thin endometrium [3,4]. Although the real mechanism of IUAs resulting in poorer pregnancy outcomes remains unclear, evidence suggests that an altered biochemical or vascular environment is a possible explanation for impaired embryo implantation and adverse pregnancy results [5].…”

Gender-inclusive writing for epidemiological research on pregnancy

“…Terms in articles using gender-inclusive language included patients, [14][15][16][17] parents, 18,19 and pregnant teens. 18 The field of first authors was associated with the use of inclusive language ( 2 (19) = 84.83, p < .001).…”

Endometrial thickness: How thin is too thin?

“…However, whether the surgical removal of all uterine pathologies (i.e., subcentimeter polyps or filmy intrauterine adhesions) improves IVF and embryo transfer outcomes remains controversial (60). The role of surgical interventions for refractory endometrium adds another complex layer, given that often, a thin endometrium results from a previous intrauterine operation and that the rate of intrauterine adhesion reformation is high (61,62). The most practical approach is via the reservation of operative hysteroscopy in patients who fail to achieve adequate EMT despite attempts using various endometrial preparation protocols (as previously described) to rule out previously undetected intrauterine adhesions or in those with an abnormal transvaginal ultrasound result concerning for uterine pathology.…”