Decrease In Endometrial Thickness Research Articles

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

Does endometrial compaction (EC) help predict pregnancy outcomes in those undergoing ART? EC is associated with a significantly higher clinical pregnancy rate (CPR) and ongoing pregnancy rate (OPR), but this does not translate to live birth rate (LBR). EC describes the progesterone-induced decrease in endometrial thickness, which may be observed following the end of the proliferative phase, prior to embryo transfer. EC is proposed as a non-invasive tool to help predict pregnancy outcome in those undergoing ART, however, published data is conflicting. A literature search was carried out by two independent authors using PubMed, Cochrane Library, MEDLINE, Embase, Science Direct, Scopus, and Web of Science from inception of databases to May 2023. All peer-reviewed studies reporting EC and pregnancy outcomes in patients undergoing IVF/ICSI treatment were included. The primary outcome is LBR. Secondary outcomes included other pregnancy metrics (positive pregnancy test (PPT), CPR, OPR, miscarriage rate (MR)) and rate of EC. Comparative meta-analyses comparing EC and no EC were conducted for each outcome using a random-effects model if I 2 > 50%. The Mantel-Haenszel method was applied for pooling dichotomous data. Results are presented as odds ratios (OR) with 95% CI. Out of 4030 screened articles, 21 cohort studies were included in the final analysis (n = 27 857). No significant difference was found between LBR in the EC versus the no EC group (OR 0.95; 95% CI 0.87-1.04). OPR was significantly higher within the EC group (OR 1.61; 95% CI 1.09-2.38), particularly when EC ≥ 15% compared to no EC (OR 3.52; 95% CI 2.36-5.23). CPR was inconsistently defined across the studies, affecting the findings. When defined as a viable intrauterine pregnancy <12 weeks, the EC group had significantly higher CPR than no EC (OR 1.83; 95% CI 1.15-2.92). No significant differences were found between EC and no EC for PPT (OR 1.54; 95% CI 0.97-2.45) or MR (OR 1.06; 95% CI 0.92-1.56). The pooled weighted incidence of EC across all studies was 32% (95% CI 26-38%). Heterogeneity due to differences between reported pregnancy outcomes, definition of EC, method of ultrasound, and cycle protocol may account for the lack of translation between CPR/OPR and LBR findings; thus, all pooled data should be viewed with an element of caution. In this dataset, the significantly higher CPR/OPR with EC does not translate to LBR. Although stratification of women according to EC cannot currently be recommended in clinical practice, a large and well-designed clinical trial to rigorously assess EC as a non-invasive predictor of a successful pregnancy is warranted. We urge for consistent outcome reporting to be mandated for ART trials so that data can be pooled, compared, and concluded on. H.A. was supported by the Hewitt Fertility Centre. S.G.P. and J.W. were supported by the Liverpool University Hospital NHS Foundation Trust. D.K.H. was supported by a Wellbeing of Women project grant (RG2137) and MRC clinical research training fellowship (MR/V007238/1). N.T. was supported by the National Institute for Health and Care Research. D.K.H. had received honoraria for consultancy for Theramex and has received payment for presentations from Theramex and Gideon Richter. The remaining authors have no conflicts of interest to report. PROSPERO CRD42022378464.

A decrease in endometrial thickness before embryo transfer is not associated with preterm birth and placenta-mediated pregnancy complications

Research questionDoes a decrease in endometrial thickness (compaction ≥10%) before embryo transfer prognosticate the risk for preterm birth and placenta-mediated pregnancy complications among IVF pregnancies? DesignRetrospective cohort study at a large private fertility practice. Patients with a singleton live birth after a fresh or frozen embryo transfer between 2016 and 2019 were included. The primary outcome was preterm birth (delivery before 37 weeks gestational age). Secondary outcomes included gestational hypertension, pre-eclampsia, intrauterine growth restriction and placental abruption. ResultsOf the 252 patients that met the study criteria, 122 (48%) demonstrated endometrial compaction (≥10%) and 130 (52%) did not. Age, body mass index (BMI), parity, history of preterm birth or history of pre-existing maternal conditions between the compaction and no-compaction groups were not significantly different. The overall prevalence of placenta-mediated complications across all participants was 25% (n = 62). The number of preterm births between the compaction and no-compaction groups (13% and 6%, respectively, P = 0.09) as well as the prevalence of placenta-mediated complications (29.5% and 20%, respectively, P = 0.08) were not significantly different. Findings for the primary outcome (preterm birth) persisted even after adjustment for potential confounding variables, including maternal age, parity, BMI, embryo score and type of embryo transfer (fresh versus frozen) (adjusted OR 1.86, 95% CI 0.64 to 5.38). ConclusionsEndometrial compaction (or decrease in endometrial thickness) before embryo transfer is not associated with preterm birth or placenta-mediated pregnancy complications.

O-190 Endometrial compaction in artificial frozen-thawed embryo transfer cycles is associated with improvement in pregnancy outcomes: a meta-analysis

Abstract Study question Does the decrease in endometrial thickness between the end of oestrogen phase and embryo transfer day (endometrial compaction) impact the pregnancy outcomes in frozen-thawed embryo transfer (FET) cycles? Summary answer The combined data indicated that cycles with endometrial compaction resulted in significantly higher ongoing pregnancy/live birth rate than cycles with no decrease in endometrial thickness. What is known already In FET cycles the monitoring of endometrial thickness was mostly concentrated at the end of the endometrium proliferation phase, while research on endometrial thickness in the luteal phase around the embryo transfer day was relatively rare. In addition, few studies have investigated the change in endometrial thickness after progesterone administration, and the conclusions are contradictory. Some studies included women who used hormone replacement therapy for endometrial preparation and showed that endometrial compaction (decreased thickness between the end of oestrogen phase and embryo transfer day) was associated with higher pregnancy rates. However, others reached different conclusions. Study design, size, duration A systematic review and meta-analyses was carried out to analyse the effect of endometrial compaction on FET cycle outcomes. The search strategy included online searching of databases (MEDLINE, EMBASE, The Science Citation Index, Google scholar, Cochrane Controlled Trials Register and OVID) up to December 2021. There was no language restriction and included grey literature. The following Medical Subject Headings and text words were used: frozen-thawed embryo transfer, hormonal preparation, endometrial thickness, endometrial compaction. Participants/materials, setting, methods Only cycles with artificial endometrial lining preparation (oestrogen-progesterone) and that compared outcomes of endometrial compaction cycles versus no endometrial compaction (no change/increased in endometrial thickness) cycles were considered. The primary outcomes were clinical pregnancy(CPR), miscarriage(MR) and ongoing pregnancy/livebirth (OPR/LBR) rates. The Breslow–Day-statistic, Q-statistic and I² (inconsistency) were used to determine the combinability of the trials. The random effects model was used for odds ratio(OR). The StatsDirect statistical software (Cheshire, UK) was used for data analysis. Main results and the role of chance Although endometrial compaction does not significantly affect CPR (OR:1.31[0.91-1.89],P=0.14) and MR (OR:1.18[0.87-1.59];P=0.27, it seems to be associated with a higher OPR/LBR (OR:1.54[1.12-2.13];P=0.007). Table 1 shows the data. Limitations, reasons for caution Some trials did not report clinical pregnancy or miscarriage rate. It could be associated with differences in the results. The retrospective nature and lack of standardisation of procedures across studies should be highlighted. Some analyses show high heterogeneity. Although statistically significant, the results in both arms are very close. Wider implications of the findings The combined results support the change in endometrial thickness as an easy, low-cost, potential noninvasive marker of endometrial receptivity. However, additional trials are still needed. Trial registration number Not applicable

Endometrial compaction is associated with increased clinical and ongoing pregnancy rates in unstimulated natural cycle frozen embryo transfers: a prospective cohort study.

To investigate the association between endometrial compaction and pregnancy rates in unstimulated natural cycle frozen embryo transfers. A single-center prospective cohort study. Endometrial thickness by transvaginal ultrasound and blood progesterone levels on the day of ovulation and the day of embryo transfer were evaluated in patients undergoing natural cycle frozen embryo transfer. Compaction was defined as > 5% decrease in endometrial thickness between ovulation day and day of transfer. Clinical and ongoing pregnancy rates in cycles with and without compaction were compared. Seventy-one women were included, of which 44% had endometrial compaction, with similar rates when subdividing the patients by day of transfer (day 3 or day 5). Clinical and ongoing pregnancy rates were higher in the compaction group compared to the non-compaction group (0.58 vs. 0.16, P < 0.001; 0.52 vs. 0.13, P < 0.001 respectively). Subdividing by degree of compaction > 10% and > 15% revealed similar pregnancy rates as > 5%, with no added benefit to higher degrees of compaction. About half the patients in our study undergoing unstimulated natural cycle frozen embryo transfer experienced compaction of the endometrium, occurring as early as day 3 post-ovulation. This was significantly correlated with increased clinical and ongoing pregnancy rates.

Effectiveness of Levonorgestrel Releasing Intrauterine System in Perimenopausal Women with Heavy Menstrual Bleeding: A Prospective Study at a Teaching Hospital in India.

To evaluate the effect of levonorgestrel-releasing intrauterine system (LNG-IUS) on heavy menstrual bleeding in perimenopausal women. This was a prospective, observational clinical study conducted on 42 perimenopausal women with heavy menstrual bleeding who met the study eligibility criteria. LNG-IUS was inserted in the postmenstrual phase following baseline evaluation. The patients were followed up at the 4, 12, and 24 weeks. Pictorial blood assessment chart (PBAC) score, hemoglobin and serum ferritin levels, and endometrial thickness were assessed before insertion and during the follow-up visits. Two patients (4.8%) were lost to follow-up, three patients (7.1%) opted for hysterectomy, two women (4.8%) experienced spontaneous expulsion and 35 (83.3%) women continued the usage. Menstrual blood loss assessed using the median PBAC score (interquartile range) significantly reduced (P < 0.001) from the pre-insertion level of 280 (246-306) to 124 (60-200) at 4 weeks to 45 (34-76) at 12 weeks and further to 32 (20-50) at the end of 24 weeks. Simultaneously, a significant (P < 0.001) improvement in the mean hemoglobin and serum ferritin levels and a significant (P < 0.001) decrease in endometrial thickness were observed. The most common side effect was spotting (50.0%) and vaginal discharge (38.1%). LNG-IUS causes a remarkable reduction in menstrual blood loss and marked improvement in dysmenorrhea. It also reduces anemia by improving the hemoglobin and ferritin levels. Thus, it can serve as an effective treatment option for heavy menstrual bleeding in perimenopausal women and prevent the need for a hysterectomy.

Decreased Endometrial Thickness Is Associated With Higher Risk of Neonatal Complications in Women With Polycystic Ovary Syndrome.

PurposeTo evaluate the association of endometrial thickness (EMT) with obstetric and neonatal outcomes in women with polycystic ovary syndrome (PCOS).MethodsA total of 1755 subfertile PCOS women with singleton livebirths after frozen-thawed embryo transfer were included between January 2009 and September 2019. Main obstetric outcomes were hypertensive disorders in pregnancy and abnormal placentation. Main neonatal outcomes were preterm birth (PTB), low birthweight (LBW) and small-for-gestational age (SGA). Crude and adjusted odds ratios (ORs) with 95% confidence intervals (CIs) were estimated by univariate and multivariate logistic regression analyses.ResultsEach millimeter decrease in EMT was related to a 9% (adjusted OR 1.09, 95% CI 1.00–1.19; P = 0.053), 14% (adjusted OR 1.14, 95% CI 1.02–1.28; P = 0.002) and 22% (adjusted OR 1.22, 95% CI 1.07–1.38; P = 0.003) higher risk of PTB, LBW and SGA, respectively. Compared to women with EMT >13 mm, women with EMT ≤8 mm also had significantly higher risk of PTB (adjusted OR 3.79, 95% CI 1.53–9.39; P = 0.004), LBW (adjusted OR 4.33, 95% CI 1.39–13.50; P = 0.012) and SGA (adjusted OR 6.38, 95% CI 1.78–22.83; P = 0.004). These associations remained consistent in further subgroup analysis by endometrial preparation regimen and in sensitivity analyses among nulligravida women or women without adverse obstetric outcomes. No significant differences were found in the incidence of several pregnancy complications across EMT categories.ConclusionDecreased EMT was independently associated with increased risk of PTB, LBW and SGA in women with PCOS.

Significance of endometrial thickness change after human chorionic gonadotrophin triggering in modified natural cycles for frozen-thawed embryo transfer.

BackgroundPeak endometrial thickness (EMT), measured on the end of follicular phase or early luteal phase, is the most widely used marker for endometrial receptivity during infertility treatment. However, the clinical significance of follicular-to-luteal EMT change remains unclear. We aimed to study whether the change of EMT between the day of human chorionic gonadotrophin (hCG) triggering and the day of frozen-thawed embryo transfer (FET) has any influence on pregnancy outcomes in modified natural cycles (mNCs).MethodsThis was a retrospective cohort study of 2,768 regular ovulatory women who underwent their first mNC-FET cycles from January 2011 to June 2015. Patients were divided into three groups according to the percentage change of EMT from the hCG triggering day to the FET day: >5% decrease (n=405), ±5% plateau (n=1,259) and >5% increase (n=1,104). The main outcome measure was live birth rate.ResultsLive birth rates were 41.9%, 39.8% [crude odds ratio (cOR) 0.91, 95% CI, 0.73–1.15) and 42.4% (cOR 1.02, 95% CI, 0.87–1.20) in the EMT plateau, decrease and increase groups, respectively (P=0.649). Multiple regression analysis did not alter the finding after controlling for a variety of confounders. Compared with the post-trigger EMT plateau group, the adjusted OR of live birth was 0.88 (95% CI, 0.69–1.12) in the decrease group and 1.05 (95% CI, 0.88–1.25) in the increase group. Similarly, no significant associations were observed before or after adjustment between EMT change and other pregnancy outcomes including positive hCG test, clinical pregnancy, early miscarriage and ongoing pregnancy.ConclusionsEMT change from hCG triggering to embryo transfer was not associated with pregnancy chances in mNC-FET cycles. This reassuring finding should provide guidance for physicians and patients when confronted with EMT decrease on the transfer day.

Value of endometrial thickness change after human chorionic gonadotrophin administration in predicting pregnancy outcome following fresh transfer in vitro fertilization cycles.

To study whether the change of endometrial thickness (EMT) between the day of human chorionic gonadotrophin (hCG) administration and the day of embryo transfer has any impact on pregnancy outcome in fresh in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) cycles. This single-center retrospective cohort study included 2620 patients undergoing their first consecutive autologous IVF/ICSI cycles from January 2003 to December 2012. Patients were categorized into three groups based on the percentage change of post-hCG EMT: > 10% decrease, ± 10% plateau and > 10% increase. The primary outcome was live birth rate. Live birth rates were similar in the EMT decrease, plateau and increase groups (27.4% [174/635], 29.7% [300/1010] and 27.6% [269/975]; P = 0.649). Compared with the plateau group, both EMT decrease (crude odds ratio [cOR] 0.89, 95% confidence interval [CI] 0.72-1.11) and increase (cOR 0.90, 95% CI 0.74-1.10) on the day of transfer did not affect the likelihood of live birth. The non-significant association was maintained after controlling for major confounding factors, with the adjusted OR being 0.92 (95% CI 0.73-1.16) and 0.92 (95% CI 0.75-1.13) for the decrease and increase groups, respectively. EMT change after hCG administration did not provide significant prognostic information for pregnancy outcome in fresh IVF/ICSI cycles. This finding should offer reassuring information for patients with decreased EMT on the day of embryo transfer while questioning the necessity of EMT re-measurement prior to transfer as a routine practice.

ULTRASOUND IMAGING PREDICTS ENDOMETRIAL RECEPTIVITY – A DECREASE IN ENDOMETRIAL THICKNESS (COMPACTION) PRIOR TO EMBRYO TRANSFER IS ASSOCIATED WITH AN INCREASE IN CLINICAL PREGNANCY RATE IN SYNTHETIC FROZEN EUPLOID IVF CYCLES

Two recently published studies demonstrated that pregnancy rates were higher among patients whose endometrium compacted (became thinner) during secretory transformation in both frozen euploid and non-PGT-A embryo transfer cycles (1, 2). An important limitation of these studies was that transabdominal ultrasound images were utilized. This study seeks to assess whether endometrial compaction (a decrease in endometrial thickness) after progesterone treatment as measured by transvaginal ultrasound (TVUS) in synthetic cryopreserved euploid IVF cycles prognosticates clinical pregnancy rates.

Changes in ultrasound uterine morphology and endometrial thickness during ovarian aging and possible associated factors: findings from a prospective study

The aim of the study was to provide reference values for sonographic measurements of uterine morphology, quantify changes in uterine morphology across the menopausal transition, and identify possible factors associated with sonographic findings in uterine morphology. This is a longitudinal cohort study conducted in middle-aged Chinese women. Using transvaginal ultrasound, we measured morphologic parameters of the uterus (volume and endometrial thickness) under standardized conditions every year for over a decade. Uterine volume begins to decrease before the final menstrual period and declines rapidly thereafter. Compared with a baseline measurement taken in the year of the final menstrual period, uterine volume decreased by 20% and 35% at the first year and second year of postmenopause, respectively. The rate of decrease was slower in the third year. Compared with endometrial thickness in the year of the final menstrual period, the figures for 2 and 3 years before the final menstrual period were 5% and 10% higher, while they decreased by 9% and 18% at the first and second year after the final menstrual period. Similarly, the endometrial thickness became relatively stable 3 years after the final menstrual cycle. These observations were fairly consistent across all women without uterine fibroids. Endometrial thickness was significantly positively associated with body mass index (P = 0.049) after adjusting for time and menopausal stage. The figures for uterine volume and endometrial thickness decrease around menopause using ultrasound measurments with large reductions in the first and second year after the final menstrual period. A higher body mass index is associated with increased endometrial thickness.

Ormeloxifene versus oral contraceptive pills in the management of DUB

Background: DUB is defined as abnormal uterine bleeding without any clinically detectable pelvic pathology. The present study was conducted to compare the efficacy and safety of ormeloxifene and combined oral contraceptive pills in medical management of DUB. Methods: 110 cases of DUB aged between 25 and 45 years were randomly assigned into two groups. Group A received Ormeloxifene 60mg twice a week for 3 months and then once a week for next 3 months. Group B received combined oral contraceptive pills (Levonorgestrel 0.15mg and Ethinylestradiol 20mcg) one tablet from the 5th day of menses for 21 days given for 6 cycles. Regular follow up was done to assess response, compliance and side effects of drug. The treatment was evaluated by measuring menstrual blood loss by PBAC (Pictoral Blood Loss Assessment Chart), Haemoglobin g/dl and endometrial thickness before and after treatment. Results: Ormeloxifene was found to be significantly more effective (P< 0.0001) than OC pills in controlling menorrhagia. There was significant decrease in endometrial thickness and improvement in Haemoglobin level in ormeloxifene group. Conclusion: Ormeloxifene is more effective and well tolerated than OC pills in treatment of DUB.

Effectiveness and safety of ormeloxifene and medroxyprogesterone acetate in dysfunctional uterine bleeding - A prospective interventional quasi-randomized interval clinical study

Background: Progestogens and selective estrogen receptor modulators are used in treating dysfunctional uterine bleeding (DUB). There is a lack of consensus regarding the best agent. Aim and Objective: To compare the effectiveness and safety of ormeloxifene and medroxyprogesterone acetate (MPA) in DUB. Materials and Methods: A comparative evaluation of gynecology outpatients with DUB at a tertiary care teaching hospital by a prospective interventional quasi-random design. Patients having DUB were allocated into two groups based on treatment with ormeloxifene (n = 20) and MPA (n = 20). Each patient was followed up for 3 months and evaluated for: (a) Menstrual blood loss assessed using pictorial blood loss assessment chart (PBAC) score and presence of clots, (b) endometrial thickness, (c) hemoglobin (Hb) level, (d) assessment of symptoms, and (e) adverse effects. Mann–Whitney U test and Chi-square test were used to compare both groups. Results: There was a significant reduction in PBAC score and passage of clots compared to baseline in both groups. An increase in Hb was statistically significant in MPA group. Decrease in PBAC score, increase in Hb, and decrease in endometrial thickness after treatment was not significant between groups. In ormeloxifene group, symptoms significantly improved after 1 month and 75% patients had amenorrhea. Conclusion: Ormeloxifene, with less frequent administration and higher tolerability, can be used as an effective alternative to MPA for controlling menstrual blood loss.

Efficacy of Ormeloxifene vs Norethisterone in the Management of Perimenopausal DUB

Background: Disorders of menstruation are the most common reason for a gynaecological consultation among women of reproductive age group. Dysfunctional Uterine Bleeding is defined as abnormal uterine bleeding in the absence of organic, systemic or iatrogenic causes. It can be managed both medically and surgically. In medical management, several drugs have been used. However there is lack of studies suggesting the most appropriate drug. The objective of our study is to compare the treatment efficacy of Norethisterone acetate (a progesterone derivative) versus Ormeloxifene (selective estrogen receptor modulator) in the treatment of DUB. Methodology: Total of 100 perimenopausal women with DUB were enrolled in our prospective study. They were randomly assigned into group A and group B. Group A was treated with 60mg Ormeloxifene two times a week for 3 months followed by once a week for another 3months. Group B was treated with Norethisterone 5 mg two times a day from Day5 to Day26 for 6 months. Primary outcome parameters noted were reduction in menstrual blood loss that was measured by fall in Pictorial Blood Loss Assessment Chart (PBAC) score, increase in haemoglobin, and decrease in endometrial thickness at the end of study. Results: In our study, the reduction in mean PBAC score with Ormeloxifene was significantly more than that seen with norethisterone after 6 months of therapy. There was a significant increase in hemoglobin level and reduction in endometrial thickness with Ormeloxifene compared to norethisterone. Patients were more compliant to Ormeloxifene because of better tolerance and convenient dosage schedule. Conclusion: In our study Ormeloxifene was found to be more effective than Norethisterone in reducing blood loss, improving haemoglobin level and reducing endometrial thickness in DUB patients.

The impact of a thin endometrial lining on fresh and frozen–thaw IVF outcomes: an analysis of over 40 000 embryo transfers

STUDY QUESTIONDoes each millimeter decrease in endometrial thickness lead to lower pregnancy and live birth rates in fresh and frozen IVF cycles?SUMMARY ANSWERClinical pregnancy and live birth rates decline as the endometrial thickness decreases below 8 mm in fresh IVF-ET and below 7 mm in frozen–thaw embryo transfer (ET) cycles.WHAT IS KNOWN ALREADYPrevious studies have been heterogenous and have shown conflicting results on the impact of endometrial thickness on IVF outcomes. Most studies do not include many patients with an endometrial thickness below 6 mm, and there are few studies of frozen–thaw ET cycles.STUDY DESIGN, SIZE, DURATIONThis study is a retrospective cohort analysis of all Canadian IVF fresh and frozen–thaw ET cycles from the CARTR-BORN database for autologous and donor fresh and frozen–thaw IVF-ET cycles from 1 January 2013 to 31 December 2015. A total of 24 363 fresh and 20 114 frozen–thaw IVF-ET cycles were reported during this timeframe.PARTICIPANTS/MATERIALS, SETTING, METHODS33 Canadians clinics participated in voluntary reporting of IVF and pregnancy outcomes to the CARTR-BORN database. The impact of endometrial thickness on pregnancy, live birth and pregnancy loss rates were analyzed for fresh IVF-ET and frozen–thaw cycles.MAIN RESULTS AND THE ROLE OF CHANCEIn fresh IVF-ET cycles, clinical pregnancy and live birth rates decreased (P < 0.0001) and pregnancy loss rates increased (P = 0.01) with each millimeter decline in endometrial thickness below 8 mm. Live birth rates were 33.7, 25.5, 24.6 and 18.1% for endometrial thickness ≥8, 7–7.9, 6–6.9 and 5–5.9 mm, respectively. In frozen–thaw ET cycles, clinical pregnancy (P = 0.007) and live birth rates decreased (P = 0.002) with each millimeter decline in endometrial thickness below 7 mm, with no significant difference in pregnancy loss rates. Live birth rates were 28.4, 27.4, 23.7, 15 and 21.2% for endometrial thickness ≥8, 7–7.9, 6–6.9, 5–5.9 and 4–4.9 mm, respectively. The likelihood of achieving an endometrial thickness ≥8 mm decreased with age (89.7, 87.8 and 83.9% in women <35, 35–39 and ≥40, respectively) (P < 0.0001).LIMITATIONS, REASONS FOR CAUTIONThis study only included cycles which proceeded to ET, which may overestimate pregnancy outcomes. Approximately 8% of cycles could not be included in the analysis due to data irregularity related to data entry. Demographic data aside from age were unavailable but may be important as lower endometrial thickness may be associated with poor ovarian response.WIDER IMPLICATIONS OF THE FINDINGSAlthough pregnancy and live birth rates decrease with endometrial thickness, reasonable outcomes were obtained even with lower endometrial thickness measurements. These data provide valuable guidance for both physicians and patients when confronted with decisions related to a persistently thin endometrium.STUDY FUNDING/COMPETING INTEREST(S)This study was not funded. The authors do not have any conflicts of interests to declare.TRIAL REGISTRATION NUMBERN/A.

Histological evaluation of vitamin-D deficiency on the endometrial decidualization in early pregnancy in rat model

ABSTRACTIntroduction: Vitamin-D is a pleiotropic secosteroid hormone that exerts classical effect in calcium uptake and bonemetabolism. In addition, it has non-classical effects on variety of organs. Endometrial decidualization, placentation, and thedevelopment of the embryo itself have all pivotal roles for normal pregnancy outcomes after embryo implantation. Earlymaternal decidua and fetal trophoblast cells illustrate expression of vitamin-D receptor and 1α-hydroxylase enzyme thatcatalyzes vitamin-D into the active metabolite, calcitriol.Aim: To record the histological effect of vitamin-D deficiency on endometrial decidualization during early pregnancy on day8 post-coitum.Materials and Methods: Thirty female albino rats were divided into 2 groups: control group (GpI) and vitamin-D deficientgroup (GpII). After establishment of pregnancy, the animals were sacrificed on the 8th gestational day. The bicornuate pregnantuteri were processed for histological analysis using H&E and PAS stains in addition to immunohistochemical staining forosteopontin (OSP), as a marker for decidualization, and for CD34 to assess the decidual angiogenesis. Morphometric andstatistical studies were performed.Results: Substantial decrease in the number of implantation sites in vitamin-D deficient rats was noted by gross examination.Histological examination revealed significant decrease in endometrial thickness at the antimesometrial region with remarkablyimpaired stromal cells differentiation. PAS staining illustrated fewer PAS positively stained uterine natural killer cells comparedto control. Weak cytoplasmic OSP immunostaining was observed in the luminal as well as glandular epithelium, vascularendothelium and few stromal cells in mesometrial region. CD34 immunostaining demonstrated impaired angiogenesis in thelateral decidua as compared to control. These findings were confirmed by morphometric and statistical analysis.Conclusion: Vitamin-D deficiency impairs the uterine stromal cells differentiation, affects the immunity tolerance andweakens decidual angiogenesis during early pregnancy in rat model.

Effect of aromatase inhibitors on the endometrium and ovary with their possible role in ovulation in adult albino rats

Introduction Aromatase inhibitors act by inhibiting estrogen synthesis and depletion of its concentrations in the circulation. Aim The aim of the study was to investigate the effect of exemestane and letrozole on the endometrium and ovary with their possible role in ovulation in adult albino rats. Materials and methods Thirty adult female albino rats were used and divided into control and experimental groups. Rats in the experimental group were further divided into subgroup IIA and subgroup IIB. In subgroup IIA each rat was given exemestane at 1 mg/kg/day and in subgroup IIB each rat was given letrozole at 5 mg/kg/day by means of a gastric tube for five consecutive ovarian cycles. Specimens from their ovaries and endometrium were taken and prepared for H&E staining and for immunohistochemical staining for vascular endothelial growth factor study. Morphometric study of endometrial thickness and surface area percentage of immunoreaction in the endometrium was evaluated. Hormonal assay of luteinizing hormone and follicular stimulating hormone was carried out. Results Significant decrease in endometrial thickness was observed in the exemestane-treated group. The letrozole-treated group revealed significantly thickened endometrium. The exemestane-treated group showed markedly disturbed ovarian architecture in the form of thickened germinal epithelial cell layer and multiple corpora lutea with atretic follicles. The letrozole-treated group revealed an ovarian cortex with multiple stages of follicular development. The vascular endothelial growth factor immunoreaction of the letrozole-treated group showed significant highly positive cytoplasmic reaction. Significant decrease in luteinizing hormone level in the exemestane group and significant increase in the letrozole group were detected. Conclusion It is concluded that letrozole improved the endometrial thickness and may have a role in ovulation induction. In contrast, exemestane led to disruption of the endometrium and ovary. Therefore, not all aromatase inhibitors help in ovulation.

Endometrial effects of a single early luteal dose of the selective progesterone receptor modulator CDB-2914

To test potential contraceptive mechanisms of the selective P receptor modulator CDB-2914 in the early luteal phase. Prospective randomized clinical trial. Clinical research center. Fifty-six women with regular cycles. Women received a single dose of CDB-2914 (10, 50, or 100 mg) or placebo given after ovulation and within 2 days of the LH surge. Four to 6 days later, a transvaginal ultrasound scan measured endometrial thickness, and an endometrial biopsy specimen was obtained. The endometrium was evaluated by thickness and by immunohistochemical analysis for P-dependent markers; safety laboratory tests were performed, and E(2) and P levels were obtained. CDB-2914 caused a significant dose-dependent decrease in endometrial thickness, an increase in glandular P receptors, and a decrease in peripheral node addressins. Estradiol and P levels and menstrual cycle timing were not altered. No adverse effects were observed. The alteration in endometrial thickness and P-dependent markers of implantation in the absence of changes in hormone levels and cycle length suggests that CDB-2914 may have contraceptive properties.

Adjuvant therapy enhances endometrial receptivity in patients undergoing assisted reproduction

Adjuvant therapies are often used to enhance endometrial thickness during IVF. This retrospective cohort analysis investigated if women undergoing oocyte donation cycles with sonographic evidence of endometrial insufficiency benefit from adjuvant medicaltherapy. Infertile patients received 503 mock cycles followed by 503 anonymous oocyte donation cycles. One hundred and twenty-three patients received adjuvant therapy during a donor oocyte cycle. Patients who had a mock endometrial thickness ≥8 mm experienced a significant decrease in endometrial thickness with the donor oocyte cycle regardless of the use of adjuvant therapy ( P < 0.001). In contrast, those patients with a mock endometrial thickness <8 mm experienced a significant increase in donor oocyte cycle endometrial thickness regardless of adjuvant therapy use ( P < 0.001). The patients with a mock endometrial thickness <8 mm experienced a significant improvement in pregnancy rates when taking adjuvant therapy (87.7 versus 73.5%, P < 0.05). Adjuvant therapy significantly improved both pregnancy (87.8 versus 76.8%, P < 0.01) and live birth rates (74.8 versus 63.7%, P < 0.05) in the entire patient population. While the use of adjuvant therapy did not significantly improve ultrasonographic endometrial thickness, it did improve outcome rates.

Quinacrine female nonsurgical sterilization (QS): endometrial assessment by vaginal ultrasonography in 128 women

Objective: Investigate effectiveness, safety and endometrial pattern after QS. Method: This study began in March 1999 and ended March 18, 2003; 128 women received transcervical insertions of quinacrine. Follow-up visits with ultrasound were scheduled at 1, 3, 6, 12-month intervals. Results: Two pregnancies occurred, one at 25 months, the other at 37. Adverse events (AE) were: yellow vaginal discharge, headache, mild abdominal pain, vaginal pruritus, nausea and transient decrease in endometrial thickness. One patient had allergic reaction. A third insertion was done in case of vaginal bleeding (16.4%). One year after QS 10% still had amenorrhea, which may be the results of the fact that 73% of our patients had received DMPH. Once inside the uterus, the dissolved quinacrine could be seen within seconds, via ultrasound as a “Lake of Quinacrine” which stays for up to two hours. Frequently, a transverse vaginal ultrasonographic view of the uterine cavity showed plug-like echogenic points at the cornua. Conclusion: Quinacrine sterilization is safe and effective. The echogenic points need to be more thoroughly studied in order to affirm whether ultrasonography may identify the blockage of the tubes. Since early pregnancy is due to imperfect tubal closure, the use of ultrasound may prevent failure. However, pregnancy due to later recanalization cannot be avoided.

Ultrasonographic measurement of endometrial changes following discontinuation of tamoxifen treatment in postmenopausal breast cancer patients.

To assess whether there is a decrease in endometrial thickness following discontinuation of tamoxifen treatment as measured by ultrasound. Prospective study. Department of Obstetrics and Gynaecology, Sapir Medical Centre, Kfar-Saba, Israel. Fifty-eight postmenopausal women with breast cancer who were treated with tamoxifen. Transvaginal ultrasonographic measurements of endometrial thickness. Evaluation of the changes of endometrial thickness and the frequency the endometrium reached a thickness of < or = 5 mm at different time intervals after stopping tamoxifen treatment. There was a significant decrease in median thickness of the endometrium, within six months after stopping tamoxifen, from 7.75 mm measured at the last ultrasonographic study performed before tamoxifen discontinuation down to 5.2 mm (P = 0.002). There were no further reductions in endometrial thickness, and it remained constantly low in subsequent ultrasonographic studies which were performed at various times up to 30 months following the discontinuation of tamoxifen treatment. While taking tamoxifen, only 25-9% of the women had an endometrial thickness of < or = 5 mm. This proportion doubled in their first six months after stopping. Median thickness of endometrial thickness significantly reduced within six months following tamoxifen discontinuation, and remained constantly low thereafter. This finding may support use of ultrasonographic imaging for the measurement of tamoxifen's effect on the endometrium of postmenopausal breast cancer patients.