Endometrial Thickness and Pattern for Assessing Endometrial Receptivity

Pregnancy Miracle

Pregnancy Miracle by Lisa Olson

Get Instant Access

Ultrasonography has been used, with varying degrees of success, to correlate the probability of pregnancy in ovarian stimulation-ovulation induction cycles and IVF cycles (73-77). Most imaging studies have been attempting to predict the probability of implantation. A thicker endometrium was observed on the day of oocyte retrieval in women who conceived during that cycle (74). The IVF pregnancy rate increased in cycles when the endo-metrium was > 9 mm but <14 mm (75). In another study, no correlation was observed among endometrial pattern or thickness and estradiol levels, number of oocytes retrieved, or progesterone level on the day of embryo transfer; however, the authors appeared to appreciate the pattern of the endometrium on the day of hCG administration, but stated that pattern assessment was of no value (78). In another IVF study, the endometrium on the day before embryo transfer was nearly 2 mm thicker in women who conceived (10.2mm) than in those who did not (8.6 mm) (79). Only two pregnancies were reported when the endometrial thickness was less than

6cm U

TOCflL

ZONES

Ovarian Follicle Aspiration Needle

6cm U

Figure 3 Ultrasound image taken during oocyte retrieval. The highly echogenic band around the distal end of the needle and the tip of the follicle aspiration needle are visualized in the superior-most follicle. The needle is maneuvered within the ovary to aspirate all follicles. Source: Image courtesy of Dr. Roger Stronell.

Figure 3 Ultrasound image taken during oocyte retrieval. The highly echogenic band around the distal end of the needle and the tip of the follicle aspiration needle are visualized in the superior-most follicle. The needle is maneuvered within the ovary to aspirate all follicles. Source: Image courtesy of Dr. Roger Stronell.

7.5 mm, and no pregnancies were observed when the endometrial thickness on the day of embryo transfer was less than 5 mm. However, no differences were observed in endometrial thickness among women who conceived compared to those who did not in a similar study (80). Subsequently, a more favorable outcome has been suggested when embryos were transferred when the endometrial thickness was greater than 9 mm and a "triple-line" pattern was observed (81). This observation was supported by a retrospective analysis in which the pregnancy rate was significantly higher in women who exhibited a triple-line pattern than in those with other endometrial patterns (Fig. 4) (82). These contradictory reports and the apparent lack of correlation between ultrasonographic endpoints and histologic staging of the endometrium in women undergoing IVF can be interpreted to suggest that ultrasonography using simple measurements is simply not yet sensitive enough to be useful in predicting endometrial receptivity and the probability of implantation with the exception of a strong negative correlation when the endometrium is thin (81,83,84). It is also possible that inconsistencies in the day on which measurements were done among the many studies and measurement techniques have played a role in our seeming inability to interpret the data. Consensus among studies is that implantation may occur as long as the endometrial thickness is greater than 6 mm, although there is a single case report of a pregnancy established when the endometrium measured 4 mm (74,85-87).

Collections of fluid are sometimes found within the uterine lumen on the day of embryo transfer (88) (Fig. 5). In a retrospective analysis of case records, approximately 5% of cycles were compromised by the presence of lumen fluid accumulation at some time during the IVF cycle procedures, and in 2% of the cases the fluid accumulations persisted until the day of embryo transfer. The pregnancy rate among women with fluid accumulations was markedly lower than those who did not exhibit intralumenal fluid. Interestingly, fluid accumulations were found in almost three times as many women with tubal factor infertility compared with other causes (88). Although lumenal fluid collection does not appear to be a common problem in IVF cycles, it does appear to have a negative impact on implantation and pregnancy rates.

Was this article helpful?

0 0
Pregnancy Guide

Pregnancy Guide

A Beginner's Guide to Healthy Pregnancy. If you suspect, or know, that you are pregnant, we ho pe you have already visited your doctor. Presuming that you have confirmed your suspicions and that this is your first child, or that you wish to take better care of yourself d uring pregnancy than you did during your other pregnancies; you have come to the right place.

Get My Free Ebook


Responses

  • roderick kennedy
    How i observe follicular imaging report/endometrium?
    8 years ago
  • Alana
    How to assess endometrial?
    8 years ago
  • TUULA
    What should be the thickness of endometrium 5 mm pregnancy?
    8 years ago
  • Ulrike
    Can i be pregnant with endometrium 8.6mm?
    3 years ago

Post a comment