C. Dietterich

Influence of endometrial thickness and echo patterns on pregnancy rates during in vitro fertilization

Previous data has suggested that improved PRs were seen in women with increased endometrial thickness as determined by sonography before oocyte retrieval. The hyperstimulation protocol used was CC-hMG. The study presented herein was initiated to evaluate if a similar trend was evident in women whose hyperstimulation protocol included the long LA-hMG therapy. We also demonstrated an improved PR in women with greater endometrial thickness, but in general, the endometrium was thicker in the pregnant women treated with the gonadotropin-releasing hormone agonist than in those treated with CC.

Increased endometrial thickness on the day of human chorionic gonadotropin injection does not adversely affect pregnancy or implantation rates following in vitro fertilization–embryo transfer

OBJECTIVES To investigate the controversy whether an increased endometrial thickness has an effect on pregnancy, implantation, or abortion rates in in vitro fertilization-embryo transfer (IVF-ET) cycles. DESIGN Retrospective analysis. SETTING A university-based IVF center. PATIENT(S) Five hundred seventy women under the age of 40. INTERVENTION(S) Measurements of endometrial thickness on day of human chorionic gonadotropin (hCG) administration. Cycles were compared by endometrial thickness of </=14 mm in 510 women to a thickness of >14 mm in 60 women. MAIN OUTCOME MEASURE(S) Implantation, pregnancy, and abortion rates. RESULT(S) Implantation, pregnancy, and abortion rates were similar in each group. In cycles where the endometrial thickness was </=14 mm, the rates were 20.9%, 43.1%, and 11.8% compared with 25.5%, 48.3%, and 13.8% in cycles >14 mm. CONCLUSION(S) No adverse effects of a thickened endometrium were demonstrated on implantation, pregnancy, or abortion rates in the first IVF-ET cycle. These findings fail to corroborate with those of Weissman et al. and support those of Yakin et al.

A matched study to determine whether low-dose aspirin without heparin improves pregnancy rates following frozen embryo transfer and/or affects endometrial sonographic parameters.

Purpose:The objective of the matched, controlled study was to determine whether low-dose aspirin therapy without heparin improves pregnancy rates following frozen embryo transfer.Methods:Thirty-six women who did not achieve a pregnancy following fresh embryo transfer and who had frozen embryos available for another transfer were included. Eighteen women were treated with 81 mg aspirin from day 2 of the cycle through pregnancy testing. If the β-human chorionic gonadotropin level was positive, aspirin was continued through the pregnancy. Eighteen women were not given aspirin. The mean outcome variables were pregnancy and implantation rates.Results:The clinical pregnancy rate in the aspirin group was 11.1%, compared with 33.3% for the controls, and implantation rates were 2.9 and 10.9%, respectively.Conclusions:No positive effects of low-dose aspirin therapy on pregnancy rates following frozen embryo transfer were observed.

The effect of consecutive cycles of clomiphene citrate therapy on endometrial thickness and echo pattern

Objective To determine whether successive cycles of clomiphene citrate affect endometrial thickness. Methods Thirty-four women presenting for treatment of anovulation, oligoovulation, or follicle maturation defects were given the smallest dose of clomiphene citrate necessary to attain a mature follicle. If no pregnancy ensued, the same dose was continued if a follicle 18–24 mm in diameter and a serum estradiol (E2) level greater than 200 pg/mL were achieved. Ethinyl E2 was supplemented for poor cervical mucus only. Endometrial thickness and echo patterns were measured each cycle at peak follicular maturation. Results There was no difference in mean endometrial thickness during the first six cycles of therapy, nor was there a trend for thickness to increase or decrease with successive cycles with or without the addition of ethinyl E2. There was no change in the distribution of echo patterns with successive cycles of clomiphene citrate. Post-treatment measures of thickness and echo pattern did not differ from baseline pre-treatment values. The homogeneous hyperechogenic pattern was the rarest. Mean serum E2 and progesterone levels at mid-cycle did not change with successive cycles. Conclusion One proposed mechanism for the dichotomy between ovulation and pregnancy rates after clomiphene citrate therapy is that the drug adversely affects the endometrium. If clomiphene citrate does affect implantation adversely, the mechanism does not seem to be related to thinning the endometrium or causing an echo pattern that indicates a poor prognosis. The data also suggest that estrogen supplementation does not influence endometrial thickness and would best be used exclusively for hostile cervical mucus.

Relationship of Endometrial Thickness and Echo Patterns on Pregnancy Rates in Patients with Luteal Phase Defects

The objective of this prospective comparative study was to investigate the relationship of sonographic measurements of the endometrium at the time of peak follicular maturation to conception outcome in patients treated for luteal phase defects (as determined by out-of-phase endometrial biopsies). Treatments for luteal phase defects included progesterone supplementation with or without follicle-maturing drugs, depending on whether the patient attained a follicle of at least 18 mm and a serum estradiol of > 200 pg/ml. No differences in pregnancy rates were found by the thickness of endometrium (< 10 vs. > or = 10 mm) or echo pattern in any of the treatment modalities. Thus, contrary to findings in stimulated cycles for in vitro fertilization, endometrial thickness at the time of peak follicular maturation is not predictive of outcome in patients treated for luteal phase defects in natural cycles.

A method to improve false interpretation of the endometrial echo pattern as homogeneous hyperechogenic

Endometrial echo patterns are generally evaluated and graded via transvaginal sonography; however, the uterine position can impede adequate visualization, giving the false impression of a hyperechogenic echo pattern before ovulation or oocyte retrieval. Transabdominal sonography can eliminate this error in the majority of cases when transvaginal ultrasound fails to provide diagnostic images of the endometrium.

A study to determine if certain sonographic uterine parameters are associated with multiple gestation

The objective was to determine if lower uterine artery vascular impedance is associated with a greater likelihood of multiple gestation. Color Doppler parameters of pulsatility index, resistance index, endometrial thickness and echo patterns were measured in oocyte/retrieval cycles on days of human chorionic gonadotropin injection, oocyte retrieval, and mid-luteal phase in cycles where at least 3 embryos were transferred. Comparisons of these parameters were made in patients with single versus multiple gestations. There was no association between uterine environment as measured by vascular impedance and endometrial thickness and number of embryos implanted. Thus, a more ideal uterine environment, at least as determined by these sonographic parameters, does not seem to facilitate multiple embryo implantations.

Non-homogeneous hyperechogenic pattern three days after frozen embryo transfer is associated with lower pregnancy rates

OBJECTIVE To evaluate the association of mid-luteal phase echo patterns and pregnancy rates (PRs) following frozen embryo transfer (ET). METHODS Sonographic evaluation of endometrial echo patterns was performed three days after ET in the first frozen ET cycle of women < 40 years of age who used their own oocytes as well as all donor oocyte recipients. RESULTS The distribution of echo patterns and clinical PRs were similar in women using their own eggs and women who used donor oocytes; therefore all data was combined. The clinical PR was 49.5% with a hyperechogenic echo pattern vs 38.8% with a non-hyperechogenic pattern, p = .007. CONCLUSION A larger study of frozen ET and mid-luteal echo pattern now demonstrates conclusions similar to the data from fresh ET in hyperstimulated in vitro fertilization (IVF)-ET cycles in that failure to attain a hyperechogenic echo pattern three days after ET is associated with lower pregnancy rates.

Relationship of Endometrial Thickness and Sonographic Echo Pattern to Endometriosis in Non-in vitro Fertilization Cycles

The objective of this study was to investigate the effect of endometriosis on the proliferation of the endometrium as determined by sonographic measurements of endometrial thickness and echo pattern at peak follicular maturation. A prospective study of 60 infertility patients was conducted in which the endometrium was evaluated sonographically, both before and after laparoscopy. Prior to laparoscopy, the mean endometrial thickness was 10.5 +/- 1.9 mm in the group without endometriosis (n = 20) and 11.7 +/- 2.8 mm in the group with endometriosis (n = 40) (p > 0.05). Following the laparoscopy, there was no change in the mean thickness within each group. The incidence of an unfavorable echo pattern was negligible in both groups. Endometriosis does not cause a reduction in endometrial thickness, nor does it appear to influence the development of an unfavorable echo pattern at time of peak follicular maturation.