Uterus and endometrium: Endometrial pattern in diethylstilboestrol-exposed women undergoing in-vitro fertilization may be the most significant predictor of pregnancy outcome

Abstract

The objective of this study was to compare prospectively pregnancy outcome as it is related to ultrasonic endometrial echo pattern in women exposed to diethylstilboestrol (DES) in utero by their mother's consumption with women not exposed to DES, all of whom were undergoing in-vitro fertilization (IVF). Pregnancy outcome relative to endometrial thickness and pattern was evaluated in 540 cycles of IVF including DES (n = 50) and non-DES-exposed (n = 490) women. Endometrial patterns were designated as p1 = solid; p2 = ring; and p3 = intermediate. DES patients exhibited p1 more often than the majority of the non-DES-exposed group. There was no significant difference in endometrial thickness among the cycles where p1 was noted when comparing the DES (10.3 mm) with the non-DES-exposed (10.7 mm) groups. Notably, within the group exhibiting p1, no pregnancies occurred in the 18 cycles of DES-exposed women compared with a 39.2% clinical pregnancy and 36.5% delivery rate in the non-DES-exposed controls (P < 0.0001 and P = 0.008 respectively). Pregnancy rates were not significantly different in the cycles where the other endometrial patterns were found when comparing the two groups. The impact of uterine shape on pregnancy outcome was also investigated. A T-shaped uterine configuration was noted in 11 out of 18 (61.1%) cycles of DES-exposed women with pattern p1 compared with nine out of 23 (39.1%) with pattern p2. Of cycles where a T-shaped uterus was demonstrated, none out of 11 (0%) with pattern p1 compared with four out of nine (44.4%) with pattern p2 resulted in pregnancy (P = 0.026). These data suggest that endometrial pattern is one of the most significant variables for pregnancy outcome in DES-exposed women undergoing IVF.

Endometrial receptivity is preserved in Diethylstilbestrol-associated and other Müllerian anomalies: Evidence from tubal embryo transfer

“…Although studies evaluating biochemical markers of endometrial receptivity are lacking, limited available data suggest adequate endometrial thickness obtained following standard controlled ovarian hyperstimulation in ART cycles in women with anomalous uteri. In a report by Noyes et al, despite a higher tendency towards a solid endometrial pattern, and a significantly thicker endometrial lining noted in non-DES compared with DES-exposed patients undergoing COH, DES-exposed uteri still reached a mean endometrial thickness of 10.1 mm (versus 11.1 mm in non-DES exposed) on the day of hCG administration [6]. In a later report, Pal et al found no difference in endometrial thickness following COH between DES-exposed women (10.0 mm) compared with infertile controls (10.0 mm) [7].…”

“…Such anomalies, secondary to antenatal diethylstilbestrol (DES) exposure or due to sporadic abnormal Müllerian duct development, are associated with structural abnormalities of the female reproductive tract, and impaired reproductive outcome. Limited available data of pregnancy success following assisted reproductive technology (ART) in women with anomalous uteri suggest decreased implantation and ongoing pregnancy rates in such women [2][3][4][5][6][7]. In a review of published reports, the highest reported implantation and ongoing pregnancy rates following ART in DES exposed women were 13.6% and 28%, respectively [6], with rates failing to exceed 10% in the remainder of published reports.…”

“…Lower implantation and pregnancy rates previously reported following ART in women with uterine anomalies were suggested to be a function of reduced receptivity of the Müllerian-derived endometrium [2][3][4][5][6][7]. Although studies evaluating biochemical markers of endometrial receptivity are lacking, limited available data suggest adequate endometrial thickness obtained following standard controlled ovarian hyperstimulation in ART cycles in women with anomalous uteri.…”

Pelvic Imaging in Reproductive Endocrinology

“…114,115 According to Rosenwaks' team, a hyperechoic endometrium is a particularly ominous sign in women exposed to DES. 253 Pregnancy outcome relative to endometrial thickness and pattern was evaluated in 540 cycles of IVF including DES (n = 50) and non-DES-exposed (n = 490) women.…”

Utérus DES. Polémiques sur l'hystéroplastie d'agrandissement. Arguments pour

“…L'expérience que nous avons tous de patientes ayant un utérus DES et menant, malgré des dysmorphies uté-rines notables, des grossesses à terme, fait que cette intervention est loin d'être systématique. Cela, en particulier, à la lueur des complications déjà citées et des autres facteurs pronostiques, en particulier endométriaux [17] et vasculaires [18]. Dans tous les cas, l'indication opératoire doit être portée à la suite d'un bilan complet s'intéressant, en particulier aux anté-cédents de la patiente, aux autres paramètres de la fertilité du couple et après une exploration comportant une hystérographie, une hystéroscopie, une échographie dimensionnelle avec éven-tuellement doppler et une coelioscopie.…”