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OBJECTIVE: To analyse the relationship between endometrial thickness and pregnancy outcome in fresh oocyte donation cycles.DESIGN: Retrospective cohort analysis. MATERIALS AND METHODS: Single centre retrospective cohort analysis of 1928 fresh single embryo transfer oocyte donation cycles. Treatment took place at a private infertility clinic (IVIRMA Valencia, Spain) between January 1st, 2016 and December 31st, 2017. We included women under 50 years old undergoing fresh oocyte-donation treatment in the context of a hormone replacement therapy (HRT) cycle for endometrial preparation. Only women with a normal uterus on the 2D ultrasound and accepting a single transfer of a day 5 blastocyst were included. Only one good quality blastocyst according to the Spanish ASEBIR classification was transferred after 5 days of progesterone administration (Micronized Progesterone, 400 mg/12h. vaginally). We excluded cases in which an endometrial preparation under a natural cycle was performed, when more than one embryo was transferred, or any good quality blastocyst was available.RESULTS: Mean age was 42.5 AE 4.8 and BMI was 23.0 AE 3.6. The overall live birth rate was 45.6%. The mean endometrial thickness was 8.7AE1.7 mm, ranging from 3.0 to 17.0 mm. The distribution by percentiles is as follows: p10¼6.9mm; p25¼7.5mm; p50¼8.5mm; p75¼9.5mm; p90¼11.0mm. For the purpose of the analysis, patients were categorized in to 6 groups defined by percentiles. LBR in women with endometrium % p10, (% 6.9 mm), was significantly reduced compared to the rest of the population (36.7% vs 46.2%; p¼0.015). When submitted to a multivariate logistic regression analysis in which all variables related to live birth rate were included (i.e. age, BMI, number of oocytes, number of fertilized oocytes and number of good quality blastocysts available), endometrial thickness remained as an independent factor related to live birth. An endometrial thickness % 6.9 mm was associated with a significantly reduced probability of live birth compared with patients with an endometrial thickness of 7 mm or more (OR: 0.70; 95% CI: 0.50-0.97).CONCLUSIONS: Our results indicate a reduction of live birth rate for more than 9 % with an endometrial thickness lower than 7 mm. This finding even remains as an independent factor after multivariate logistic regression analysis controlling for all potentially relevant confounders. To our best knowledge this study seems to represent the largest cohort investigating live birth rate in fresh oocyte donation cycles and including only single embryo transfers.

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