Endometrial compaction and serum progesterone measurements at the day of embryo transfer cannot predict pregnancy outcomes in frozen-thaw embryo transfer cycles

Abstract

Endometrial receptivity plays a basic role in successful embryo implantation and pregnancy outcomes and can be assessed by many of non-invasive markers. Our study evaluated the impact of two of these markers specifically serum progesterone and endometrial thickness at embryo transfer day in prediction pregnancy outcomes on (60) patients attempting medicated frozen embryo transfer (FET) cycles. All patients were received sequential estrogen & progesterone medications for endometrial preparation then submitted to measurements of endometrial thickness (EMT) by transvaginal-ultrasound (TV-US) & serums progesterone (P) analysis at the embryo transfer day, thereafter day 3 verified-thawed embryos grades (A±B) were transferred. Compacted (decreased) EMT was seen in 48.3% of patients with higher pregnancy rate (PR) of 58.6%t than non-compacted EMT (no change or increased) which was seen in 51.7% of patients with (PR) of 29.0%, (P value=0.021). However ongoing pregnancy rate (Ong PR) not differed significantly between both groups (44.8% in compacted vs 25.8% in non-compacted, P value=0.053), also the means of serum P not differed between pregnant and non-pregnant patients (P value=0.374). ROC curves for Ong PR prediction in relations to endometrial compaction & serum progesterone at embryo transfer day were poor (AUC= 0.630, & AUC=0.576, respectively). This study suggested that endometrial compaction or serum P levels measurements at embryo transfer day were poor predictors for ongoing pregnancy where any kind of EMT changes (decreased or not) seen after P administration not significantly affect pregnancy outcomes in frozen-thaw cycles of cleavage stage embryos transfer.

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. In 2 fresh ETs ( 21 , 27 ) and 2 FET-mNC ( 17 , 29 ) studies, ECR refers to the rate at which EMT changes from hCG triggered to 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.…”

Endometrial compaction to predict pregnancy outcomes in patients undergoing assisted reproductive technologies: a systematic review and meta-analysis

“…In recent years, several studies have tried to determine if EC is linked to reproductive outcomes with inconsistent evidence published ( Haas et al , 2019 ; Zilberberg et al , 2020 ; Riestenberg et al , 2021 ; Yaprak et al , 2021 ; Shah et al , 2022 ). Some authors report no correlation between EC and pregnancy outcomes ( Huang et al , 2020 , 2021 ; Jarrah et al , 2021 ; Riestenberg et al , 2021 ; Gursu et al , 2022 ; Shah et al , 2022 ), whilst others have observed a positive association between EC and pregnancy rates ( Haas et al , 2019 ; Zilberberg et al , 2020 ; Kaye et al , 2021 ; Yaprak et al , 2021 ; Youngster et al , 2022 ). If shown to be beneficial, EC could be a valuable way to help predict pregnancy outcomes in patients undergoing ART and could be an inexpensive method of guiding the timing of ET to synchronise with endometrial receptivity.…”

“…Ultrasound follow-up of natural menstrual cycles shows that the EMT reaches a peak just before ovulation and then either plateaus or thins, giving rise to EC ( Youngster et al , 2022 ). Some studies looking at EC have attempted to correlate it with serum oestradiol and progesterone levels, however, poor correlation exists ( Jarrah et al , 2021 ; Olgan et al , 2022 ; Youngster et al , 2022 ; Ju et al , 2023 ). Endometrial progesterone receptor deficiency, or resistance, may explain differences in EC among different patients/cycles as serum progesterone levels are not necessarily consistent with those within endometrial tissue ( Usadi et al , 2008 ; Lawrenz and Fatemi, 2022 ).…”