Management of suboptimal sonographic endometrial patterns in patients undergoing in-vitro fertilization and embryo transfer

Abstract

A total of 816 women who underwent 1332 cycles of ovarian stimulation for in-vitro fertilization and embryo transfer (IVF/ET) had sonographic assessments of the endometrium within 2 days of oocyte retrieval. Endometrial linings were classified on the basis of thickness and echogenicity, using a grading system described previously. Grades I and IIB ('poor') were associated with a 6% viable pregnancy rate (advanced beyond 12 weeks' gestation) compared with a 29% rate for Grade IIA ('optimal'). In a subset of 112 women with poor endometrial linings during natural cycles, eight out of 21 women (38%) under 40 years of age developed optimal linings following ovarian stimulation with menotrophins, while 19 out of 91 women (21%) aged 41-45 years converted to optimal linings. Twenty-two out of 47 women (44%) who failed to develop optimal endometrial linings following ovarian stimulation converted to Grade IIA during subsequent cycles of exogenous oestrogen replacement. The financial, emotional, and physical burden associated with IVF/ET demands that patients with poor endometrial linings following ovarian stimulation with menotrophins be counselled with regard to either cancelling their cycles of treatment, or having their embryos cryopreserved for transfer to the uterus during a subsequent hormonal replacement cycle.

First Trimester Pregnancy Loss May Temporary Reduce the Ovarian Response during the Subsequent IVF Cycle

“…Nevertheless, some studies suggest that the magnitude of endometrial thickness may be associated with the reduction of pregnancy rates [24] [25]. Authors such as Moon et al [26] demonstrated the same results as ours regarding endometrial thickness post-dilatation and curettage with recovery of endometrial thickness 6 months post-miscarriage.…”

A meta-analysis of the relationship between endometrial thickness and outcome of in vitro fertilization cycles

“…The day of hCG administration,[112134071] the day before hCG administration,[911–1322242528293941–4973] the day of oocyte retrieval,[13202646] and the day of embryo transfer[13155074] were used in various studies. Another factor which is also different among studies is that different treatment and stimulation protocols were applied including natural cycles with cryopreserved embryo transfer,[4275] natural cycles with fresh embryo transfer,[40] ovarian stimulation cycles for IVF with different stimulation protocols such as long GnRHa down-regulation,[163031404251–53] clomiphene citrate with HMG, short GnRHa down-regulation,[2254] HMG only,[76] and hormone replacement therapy with oocyte donation. [193242557778]…”

Relationship between endometrial thickness and embryo implantation, based on 1,294 cycles of in vitro fertilization with transfer of two blastocyst-stage embryos

“…In an uncontrolled study, Sher et al (33) suggested that IM administration of estrogen improved endometrial quality in some patients with a history of poor endometrial quality following ovarian stimulation. A small prospective, randomized study among donor-oocyte recipients who produced a thin endometrial lining in a test cycle reported significantly better implantation rates, but not PRs, among patients taking low-dose aspirin (34), although there was no apparent difference in endometrial thickness with or without aspirin treatment.…”