Pregnancy: Endometrial ultrasonography as a predictor of pregnancy in an in-vitro fertilization programme

Abstract

The endometrial pattern and thickness were analysed by ultrasonography in 139 cycles stimulated for in-vitro fertilization (IVF) on the day of administration of human chorionic gonadotrophin (HCG). A semi-programmed schedule based on the pill + clomiphene citrate + human menopausal gonadotrophin (HMG) was used in all cycles. On the day of HCG administration, endometrial pattern and thickness were assessed with an Ultramark 4 (ATL) ultrasound equipped with a 5 MHz vaginal probe. Endometrial pattern I (a 'triple-line' multilayer) was observed in a total of 105 cycles (76%), and pattern II (fully homogeneous and hyperechogenic in relation to myometrial tissue) in 34 (24%). The incidence of clinical pregnancy did not differ (P = 0.52) between the groups with endometrial patterns I (23.8%) and II (29.4%). Endometrial thickness on the day of HCG administration in the group with pattern I (8.4 +/- 1.9 mm) was similar (P = 0.96) to that observed in the group with pattern II (8.4 +/- 2.0 mm). In addition, the endometrial thickness of the patients who became pregnant (8.0 +/- 1.7 mm) did not differ (P = 0.15) from that of women who did not achieve pregnancy (8.6 +/- 2.0 mm). The conclusion from the present data is that ultrasonographic analysis of endometrial thickness and refringency on the day of HCG administration had no predictive value for conception in IVF cycles.

Thin unresponsive endometrium—a possible complication of surgical curettage compromising ART outcome

“…Despite the existence of quite a few published studies, the prognostic value of ultrasonographic endometrial thickness measurements (and other parameters) in predicting implantation and pregnancy rates remains controversial. Some investigators have demonstrated a positive correlation between endometrial thickness and pregnancy rates [1][2][3][4][5][6][7][8]11] while others have not found such an association [9,10,[12][13][14], or only in association with other parameters [15,16]. However, these differences may be in part attributed to different patient populations, stimulation protocols used or measurement timing.…”

“…While some studies have shown that this parameter is important for predicting the outcome of In Vitro Fertilization (IVF) cycles [1][2][3][4][5][6][7][8], other studies have failed to show such a positive relationship [9][10][11][12][13][14]. In a third category of studies the endometrial thickness was related to the IVF outcome, but only in correlation with other parameters [15,16].…”

Endometrium-to-Myometrium Relative Echogenicity Coefficient

“…The premature appearance of a hyperechoic pattern at the time of ovulation was a bad prognostic sign for pregnancy [5,10]. Different conclusions among authors concerning the correlation between mean endometrial thickness or specific echogenic patterns and likelihood of subsequent conception [11,12] may be in part due to a difference in technique, inconsistencies in the day of endometrial assessment, different ovarian stimulation protocols and inherent subjectivity of endometrial morphological assessment.…”

Assessment and treatment of repeated implantation failure (RIF)

“…Indeed, several studies have reported a strong association between endometrial thickness and successful implantation [12,23,32,41,69,91]. However, others failed to confirm such an association [39,53,71,115]. The minimal adequate endometrial thickness for successful implantation, as measured in the late proliferative phase, varies between studies, with a range of 6-8 mm.…”