The results of assisted reproductive technology programs in patients with “thin” endometrium

Cover Page

Cite item

Full Text

Abstract

Relevance. Effectiveness of assisted reproductive technology (ART) programs is quite high, but for couples who have already had failed attempts of ART programs the likelihood of getting pregnant decreases with each subsequent attempt. Low endometrial thickness is a common cause of a decline in a possibility of getting pregnant. However, data on predictive value of this index in ART programs are contradictory. Some researchers do not find a correlation between the endometrium thickness and ART programs outcomes. Other researchers revealed a statistically significant relationship between endometrium thickness and pregnancy rate in ART cycles. Aim. To evaluate an effect of “thin” endometrium on pregnancy rate in ART programs. Materials and methods. 154 couples who applied for infertility treatment in ART programs were included in this prospective study. The patients were stratified into groups depending on whether a pregnancy to occur: Group 1 (n=43) - pregnancy occurred and Group 2 (n=111) - pregnancy did not occur. Then the endometrial thickness threshold determining pregnancy occurrence was identified by ultrasound and two additional groups were formed: Group 3 (n=85) - patients with “thin” endometrium, Group 4 (n=69) - patients with normal endometrial thickness. Results. The endometrial thickness threshold at which pregnancy probability, as well as the model and area under the curve (AUC) reliability were maximum, was 8.0 mm (AUC=86.7%, sensitivity - 97.7%, specificity - 75.7%). The adjusted odds ratio of pregnancy occurrence depending on endometrial thickness given the excellent quality blastocysts obtained, was 9.1 (95% confidence interval 4.3-19.3). Factors affecting endometrial thickness were endometrial polyps with polypectomy and spontaneous miscarriages in anamnesis that was undoubtedly associated with an inflammatory genesis of endometrial damage Conclusions. "Thin" endometrium plays a negative role in ART programs reducing pregnancy likelihood by 9.1 times.

About the authors

F Abdurakhmanova Nigora

V.I.Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology

Email: abd.nigora@yandex.ru
Graduate Student of Department of Assisted Technology in Infertility Treatment 4, Akademika Oparina st., Moscow, 117997, Russian Federation

D Gvozdeva Anna

National Medical Research Center for Cardiology

Resident Doctor 15a, 3-ia Cherepkovskaia st., Moscow, 121552, Russian Federation

M Ziganshina Marina

V.I.Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology

Email: mmz@mail.ru
PhD, Leading Researcher of clinical immunology laboratory 4, Akademika Oparina st., Moscow, 117997, Russian Federation

V Dolgushina Nataliya

V.I.Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology

Email: n_dolgushina@oparina4.ru
PhD, deputy director - Head of the Department of Scientific Activities Organization 4, Akademika Oparina st., Moscow, 117997, Russian Federation

References

  1. Kumbak B, Erden H.F, Tosun S et al. Outcome of assisted reproduction treatment in patients with endometrial thickness less than 7 mm. Reprod Biomed Online 2009; 18 (1): 79-84.
  2. Zhang T, Li Z, Ren X et al. Endometrial thickness as a predictor of the reproductive outcomes in fresh and frozen embryo transfer cycles: A retrospective cohort study of 1512 IVF cycles with morphologically good-quality blastocyst. Medicine (Baltimore) 2018; 97 (4): e9689. doi: 10.1097/MD.0000000000009689
  3. Liu K.E, Hartman M, Hartman A et al. The impact of a thin endometrial lining on fresh and frozen-thaw IVF outcomes: an analysis of over 40 000 embryo transfers. Hum Reprod 2018; 33 (10): 1883-8. doi: 10.1093/humrep/dey281
  4. Gonen Y, Casper R.F, Jacobson W, Blankier J. Endometrial thickness and growth during ovarian stimulation: a possible predictor of implantation in in vitro fertilization. Fertil Steril 1989; 52 (3): 446-50.
  5. Oliveira J.B, Baruffi R.L, Mauri A.L et al. Endometrial ultrasonography as a predictor of pregnancy in an in-vitro fertilization programme after ovarian stimulation and gonadotrophin-releasing hormone and gonadotrophins. Hum Reprod 1997; 12 (11): 2515-8.
  6. Khalifa E, Brzyski R.G, Oehninger S et al. Sonographic appearance of the endometrium: the predictive value for the outcome of in-vitro fertilization in stimulated cycles. Hum Reprod 1992; 7 (5): 677-80.
  7. Serafini P, Batzofin J, Nelson J, Olive D. Sonographic uterine predictors of pregnancy in women undergoing ovulation induction for assisted reproductive treatments. Fertil Steril 1994; 62 (4): 815-22.
  8. Weiss N.S, van Vliet M.N, Limpens J et al. Endometrial thickness in women undergoing IUI with ovarian stimulation. How thick is too thin? A systematic review and meta-analysis. Hum Reprod 2017; 32 (5): 1009-18. doi: 10.1093/humrep/dex035
  9. Sher G, Herbert C, Maassarani G, Jacobs M.H. Assessment of the late proliferative phase endometrium by ultrasonography in patients undergoing in-vitro fertilization and embryo transfer (IVF/ET). Hum Reprod 1991; 6 (2): 232-7.
  10. Check J.H, Lurie D, Dietterich C et al. Adverse effect of a homogeneous hyperechogenic endometrial sonographic pattern, despite adequate endometrial thickness on pregnancy rates following in-vitro fertilization. Hum Reprod 1993; 8 (8): 1293-6.
  11. Приказ Минздрава России №107н от 30 августа 2013 г. «О порядке использования вспомогательных репродуктивных технологий, противопоказаниях и ограничениях к их применению». https: //www.rosminzdrav.ru/documents/6787-Prikaz-Minzdrava-Rossii-107n-. [Prikaz Minzdrava Rossii №107n ot 30 avgusta 2013 g. "O poriadke ispol'zovaniia vspomogatel'nykh reproduktivnykh tekhnologii, protivopokazaniiakh i ogranicheniiakh k ikh primeneniiu". https: //www.rosminzdrav.ru/documents/6787-Prikaz-Minzdrava-Rossii-107n-]
  12. Gardner D.K, Schoolcraft W.B. Culture and transfer of human blastocysts. Curr Opin Obstet Gynecol 1999; 11 (3): 307-11.
  13. Fatemi H.M, Popovic-Todorovic B, Ameryckx L et al. In vitro fertilization pregnancy in a patient with proven chronic endometritis. Fertil Steril 2009; 91 (4): 1293.e9-1293.e11. doi: 10.1016/j.fertnstert.2008.12.050.
  14. Noyes N, Liu H.C, Sultan K et al. Endometrial thickness appears to be a significant factor in embryo implantation in in-vitro fertilization. Hum Reprod 1995;10 (4): 919-22.
  15. Rinaldi L, Lisi F, Floccari A et al. Endometrial thickness as a predictor of pregnancy after in-vitro fertilization but not after intracytoplasmic sperm injection. Hum Reprod 1996; 11 (7): 1538-41.
  16. Weissman A, Gotlieb L, Casper RF. The detrimental effect of increased endometrial thickness on implantation and pregnancy rates and outcome in an in vitro fertilization program. Fertil Steril 1999; 71 (1): 147-9.
  17. Bassil S. Changes in endometrial thickness, width, length and pattern in predicting pregnancy outcome during ovarian stimulation in in vitro fertilization. Ultrasound Obstet Gynecol 2001; 18 (3): 258. doi: 10.1046/j.1469-0705.2001.00502.x
  18. Kovacs P, Matyas S, Boda K, Kaali S.G. The effect of endometrial thickness on IVF/ICSI outcome. Hum Reprod 2003; 18 (11): 2337-41.
  19. Dain L, Bider D, Levron J et al. Thin endometrium in donor oocyte recipients: enigma or obstacle for implantation? Fertil Steril 2013; 100 (5): 1289-1295.e2. doi: 10.1016/j.fertnstert.2013.07.1966
  20. Miwa I, Tamura H, Takasaki A et al. Pathophysiologic features of “thin” endometrium. Fertil Steril 2009; 91 (4): 998-1004. doi: 10.1016/j.fertnstert.2008.01.029
  21. Takasaki A, Tamura H, Taketani T et al. A pilot study to prevent a thin endometrium in patients undergoing clomiphene citrate treatment. J Ovarian Res Bio Med Central 2013; 6 (1): 94. doi: 10.1186/1757-2215-6-94
  22. Esmailzadeh S, Faramarzi M. Endometrial thickness and pregnancy outcome after intrauterine insemination. Fertil Steril 2007; 88 (2): 432-7. doi: 10.1016/j.fertnstert.2006.12.010
  23. Sharara F.I, Lim J, McClamrock H.D. Endometrial pattern on the day of oocyte retrieval is more predictive of implantation success than the pattern or thickness on the day of hCG administration. J Assist Reprod Genet 1999; 16 (10): 523-8.
  24. Sereepapong W, Suwajanakorn S, Triratanachat S et al. Effects of clomiphene citrate on the endometrium of regularly cycling women. Fertil Steril 2000; 73: 287-91.
  25. Isaacs J.D, Wells C.S, Williams D.B et al. Endometrial thickness is a valid monitoring parameter in cycles of ovulation induction with menotropins alone. Fertil Steril 1996; 65 (2): 262-6.
  26. Kuć P, Kuczyńska A, Topczewska M et al. The dynamics of endometrial growth and the triple layer appearance in three different controlled ovarian hyperstimulation protocols and their influence on IVF outcomes. Gynecol Endocrinol 2011; 27 (11): 867-73. doi: 10.3109/09513590.2010.540602
  27. Apparao K.B.C, Lovely L., Gui Y et al. Elevated endometrial androgen receptor expression in women with polycystic ovarian syndrome. Biol Reprod 2002; 66 (2): 297-304.
  28. O’Donnell R.L, Warner P, Lee R.J et al. Physiological sex steroid replacement in premature ovarian failure: randomized crossover trial of effect on uterine volume, endometrial thickness and blood flow, compared with a standard regimen. Hum Reprod 2012; 27 (4): 1130-8. doi: 10.1093/humrep/des004

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

Copyright (c) 2019 Consilium Medicum

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

Согласие на обработку персональных данных

 

Используя сайт https://journals.rcsi.science, я (далее – «Пользователь» или «Субъект персональных данных») даю согласие на обработку персональных данных на этом сайте (текст Согласия) и на обработку персональных данных с помощью сервиса «Яндекс.Метрика» (текст Согласия).