The change in endometrial thickness following progesterone exposure correlates with in vitro fertilization outcome after transfer of vitrified-warmed blastocysts

Abstract

Purpose To determine if the change in endometrial thickness following exogenous progesterone (P) initiation correlates with outcome following autologous transfer of a single thawed blastocyst. Methods The study is a retrospective observational cohort study conducted at a private fertility center. Patients scheduled for thawed blastocyst transfer received artificial endometrial preparation (artificial cycle FET) and underwent serial ultrasonography. The main outcomes were the rate of ongoing pregnancy (fetal heart motion at 12 weeks of gestation) and early pregnancy loss. Logistic regression was used to test for correlations between these outcomes and the change in endometrial thickness while adjusting for potential confounders (patient age, embryo quality, and the use of genetic testing). Results There were 232 qualifying autologous single-blastocyst transfers in the 20-month study period ending 31 December 2019. Mean endometrial thicknesses were 3.8 mm, 10.0 mm, and 11.2 mm at baseline, P initiation, and at transfer, respectively. The change in endometrial thickness after exogenous P exposure ranged from − 5 to + 9 mm and negatively correlated with ongoing pregnancy in logistic regression analyses. Specifically, ongoing pregnancy rates per transfer were 63.2% in 19 cases where endometria compacted by 10% or more, 64.2% in 95 cases where there was unchanged endometrial thickness, and 52.5% in 118 cases where endometria expanded. Conclusions The change in endometrial thickness after P initiation was associated with the probability of ongoing pregnancy but not with early pregnancy loss. Ongoing pregnancy rates were greater in endometria with negative growth (compaction) when compared to endometria that grew (expanded) after P exposure.

Investigating the impact of endometrial compaction on clinical pregnancy rate in artificial frozen-thawed embryo transfer cycles

“…To cite an example, in a study by Haas et al, the continuing pregnancy rate was significantly higher in EC group whereas Jin et al reported that the CPR was higher in cycles that had no EC [7,13]. In contrast with Jin et al, Kaye showed that the CPR was higher in EC group [14]. In accordance with our study, Olgan determined that CPR did not differ between EC and noncompaction groups [15].…”

Does endometrial compaction before embryo transfer affect pregnancy outcomes? a systematic review and meta-analysis

“…In five studies of FET-HRT ( 13 , 14 , 22 , 23 , 31 ) and one study with fresh oocyte donation ( 26 ), ECR was defined as the rate of change in EMT between the day of progesterone administration and the day of ET. In 7 other FET-HRT studies ( 12 , 18 – 20 , 24 , 25 , 28 ), ECR was defined as the rate of change at which EMT changed from the end of estrogen-only phase to the ET or the day before the ET.…”

“…A total of 7 prospective studies and 11 retrospective studies were included. Of these, 11 studies ( 17 , 18 , 20 – 22 , 24 , 26 – 29 , 31 ) did not find a statistically significant association between endometrial compaction and pregnancy outcomes, whereas in 5 studies ( 12 , 19 , 23 , 25 , 30 ) better pregnancy outcomes were reported. In contrast, Bu et al.…”

“…After ovulation, the endometrium becomes more curved and vascularized by progesterone, and the EMT becomes thinner or unchanged, which appears hyperechoic on ultrasound. Researchers ( 12 , 19 , 20 , 23 , 30 , 36 ) reported that the degree of endometrial compaction can indicate the degree of endometrial response to progesterone and contribute to an assessment of ER. However, Olgan et al.…”

comparison between the effect of different medical drugs used to improve endometrial receptivity in patients with thin poorly vascularized endometrium

“…When there is no visible physical abnormality in the endometrium, these measures have used as an indicator of the receptivity of the endometrium receptivity (Sadek et al, 2022), (Krief et al, 2019). It's generally understood that the proper thickness of endometrial and vascularity are required for a successful pregnancy, and multiple theses have reported poor pregnancy scores in women with weak, poorly vascularized endometrium (Kaye et al, 2021). Although physicians disagree on the ideal endometrial thickness for conception, there is agreement that endometrial thickness less than 7 mm on ultrasound is typically regarded sub-optimal for embryo transfer and is linked to a lower chance of pregnancy (Alaa, et al, 2021)..…”