Endometrial Thickness In Women Research Articles

Recombinant human luteinizing hormone increases endometrial thickness in women undergoing assisted fertility treatments: a systematic review and meta-analysis.

The optimal dosage of recombinant human luteinizing hormone (r-hLH) and its impact on endometrial thickness (EMT) when administered alongside recombinant human follicle-stimulating hormone (r-hFSH) during controlled ovarian stimulation (COS) for in vitro fertilization/intracytoplasmic sperm injection and embryo transfer are uncertain, which formed the aims of this systematic review and meta-analysis. A search was performed in PubMed, Cochrane Library, Web of Science, EMBASE, CNKI, and Wanfang from its inception to 10 July 2023. Twenty-seven Randomized controlled trials comparing r-hFSH/r-hLH co-treatment with r-hFSH alone during in vitro fertilization/intracytoplasmic sperm injection and embryo transfer (IVF/ICSI-ET) were included. Pooled odds ratios (OR) for dichotomous data and mean differences (MD) for continuous data, with their respective 95% confidence intervals (CI), were generated. Meta-analysis employed fixed-effect or random-effect models based on heterogeneity, using Q-test and I2-index calculations. The main outcomes included EMT on trigger day, clinical pregnancy rate (CPR) and live birth rate (LBR). r-hFSH/r-hLH significantly increased EMT on trigger day (MD = 0.27; 95% CI, 0.11-0.42; I2 = 13%), but reduced oocyte number (MD = -0.60; 95% CI, -1.07 to -0.14; I2 = 72%) and high-quality embryos (MD = -0.76; 95% CI, -1.41 to -0.10; I2 = 94%) than r-hFSH alone, more pronounced with the gonadotrophin-releasing hormone agonist long protocol. A subgroup analysis showed r-hLH at 75 IU/day increased CPR (OR = 1.23; 95% CI, 1.02-1.49; I2 = 16%) and EMT on trigger day (MD = 0.40; 95% CI, 0.19-0.61; I2 = 0%). Participants ≥35years of age exhibited decreased retrieved oocytes (MD = -1.26; 95% CI, -1.78 to -0.74; I2 = 29%), but an increase in EMT on trigger day (MD = 0.26; 95% CI, 0.11-0.42; I2 = 29%). r-hFSH/r-hLH during COS significantly improved EMT compared to r-hFSH alone. An r-hLH dose of 75 IU/day may be considered for optimal pregnancy outcomes, which still require further clinical studies to support this dosing regime. [www.crd.york.ac.uk/PROSPERO], identifier [CRD42023454584].

Association between Serum Progesterone Levels and Endometrial Status on hCG Injection in IVF Cycle

Background: Endometrial thickness is a determining factor in successful implantation and pregnancy. So, this study is aimed at assessing the association between the serum levels of progesterone and endometrial status on the day of hCG injection in women treated with in-vitro fertilization (IVF). Methods: Totally, 71 women who underwent IVF cycle were prospectively recruited in this study. On the day of hCG injection, their serum progesterone levels were evaluated with the ELISA kit. The endometrial thickness was examined using transvaginal ultrasound. Patients were divided into two groups, including patients with progesterone ? 1 ng /ml and progesterone> 1 ng/ml. Eventually, patients' demographic and clinical features were statistically compared between two groups. Results: Among all the evaluated demographic and clinical factors, only the rate of nulligravid (P= 0.03) and abortion (P= 0.02) in the progesterone group ? 1 ng/ml was significantly higher than their rate in the progesterone group > 1 ng/ml. Moreover, the mean (SD) endometrial thickness was not significantly different between the two groups (P= 0.83). Conclusion: No significant relationship existed between the serum level of progesterone on the day of hCG injection and the endometrial thickness in women treated with IVF. However, a significant negative correlation existed between its level and the rate of gravidity and abortion.

Agonist long protocol improves outcomes of vitrified-warmed embryo transfer in repeatedly thin endometrium

Research questionDoes follicular stimulation using human menopausal gonadotrophin (HMG) after pituitary down-regulation by a GnRH agonist improve endometrial thickness (EMT) and clinical outcomes of frozen-thawed embryo transfer (FET; using vitrified-warmed embryos) in women with thin endometrium after intensified oestrogen administration (IOA)? DesignThis was a retrospective study. A total of 627 patients attempted 683 FET cycles with at least one previous history of thin endometrium. None of the cycles reached over 7 mm EMT after using oral and vaginal oestradiol for more than 21 days (IOA protocol). A total of 129 cycles proceeded with FET, 305 cycles were cancelled, and 249 cycles involved administration of HMG following GnRH agonist pituitary down-regulation (GnRH agonist + HMG protocol) for further endometrial preparation. ResultsEMT became significantly greater (7.18 ± 1.14 mm versus 6.13 ± 0.63 mm, P < 0.001) using GnRH agonist + HMG compared with previous IOA cycles, but this was not related to serum oestrogen concentrations. A total of 213 cycles after the GnRH agonist + HMG protocol proceeded with FET, showing a significantly increased clinical pregnancy rate, implantation rate and live birth rate compared with those after IOA. ConclusionsThe GnRH agonist + HMG protocol for endometrial preparation in FET cycles improves EMT in women with a thin endometrium after IOA and showed significantly better clinical outcomes than IOA. The authors suggest that the GnRH agonist + HMG protocol should be used for EMT that is less than 7 mm after there has been no optimal response to IOA.

Role of Serum Leptin Levels in Women with Primary Subfertility.

Subfertility significantly affects couples and their families and challenges obstetrics and gynecologists with long-term treatment. Leptin has been widely studied in different types of infertility. However, the results of previous studies are contradictory and the role of leptin is still debated in the reproductive process. The present study aimed to investigate the relationship between serum leptin concentration and some reproductive hormones and endometrial thickness in women with primary subfertility. The present case-control study was conducted from December 2020 to July 2021. A total of 100 women with primary subfertility and 100 fertile women participated in this study as a control group. Blood samples were collected and ultrasonography examinations were performed on all patients. The recorded data indicated that the mean leptin level was higher in women with subfertility compared to that of the control group, 26.8±15.2 ng/mL and 6.4±2.3 ng/mL, respectively (P<0.001). Leptin level significantly increased with a higher body mass index (P<0.001). Leptin at a level of 11 ng/ml or higher is a significant predictor of infertility (odds ratio=2.793). Leptin levels showed high sensitivity, specificity, and accuracy of 96%, 98%, and 96.9%, respectively as predictors of subfertility. As a result, a high leptin level was a strong and valid predictor of subfertility.

Ultrasound features of endometrial pathology in women without abnormal uterine bleeding: results from the International Endometrial Tumor Analysis study (IETA3).

The primary aim of this study was to describe the ultrasound features of various endometrial and other intracavitary pathologies in women without abnormal uterine bleeding (AUB) using the International Endometrial Tumor Analysis (IETA) terminology. The secondary aim was to compare our findings with published data on women with AUB. This was a prospective observational study of women presenting at one of seven centers specialized in gynecological ultrasonography, from 2011 until 2018, for indications unrelated to AUB. All patients underwent transvaginal ultrasound using the IETA examination and measurement techniques. Ultrasonography was performed as part of routine gynecological examination or follow-up of non-endometrial pathology, or as part of the work-up before undergoing treatment for infertility, uterine prolapse or ovarian pathology. Ultrasound findings were described using the IETA terminology. Endometrial sampling was performed after the ultrasound scan. The histological endpoints were endometrial atrophy, proliferative or secretory endometrium, endometrial hyperplasia without atypia, endometrial polyp, intracavitary leiomyoma, endometrial intraepithelial neoplasia (EIN), endometrial cancer (EC) and insufficient tissue. The findings in our cohort of women without AUB were compared with those in a published cohort of women with AUB who were examined with transvaginal ultrasound between 2012 and 2015 using the same IETA examination technique and terminology. In this study (IETA3), we included 1745 women without AUB who underwent a standardized transvaginal ultrasound examination followed by either endometrial sampling with histological diagnosis (n = 1537) or at least 1 year of clinical and ultrasound follow-up (n = 208). Of these, 858 (49.2%) women were premenopausal and 887 (50.8%) were postmenopausal. Histology showed the presence of EC and/or EIN in 29 (1.7%) women, endometrial polyps in 1028 (58.9%), intracavitary myomas in 66 (3.8%), proliferative or secretory changes or hyperplasia without atypia in 144 (8.3%), endometrial atrophy in 265 (15.2%) and insufficient tissue in five (0.3%). Most cases of EC or EIN (25/29 (86.2%)) were diagnosed after menopause. The mean endometrial thickness in women with EC or EIN was 11.2 mm (95% CI, 8.9-13.6 mm), being on average 2.4 mm (95% CI, 0.3-4.6 mm) thicker than their benign counterparts. Women with malignant endometrial pathology manifested more frequently non-uniform echogenicity (22/29 (75.9%)) than did those with benign endometrial pathology (929/1716 (54.1%)) (difference, +21.8% (95% CI, +4.2% to +39.2%)). Moderate to abundant vascularization (color score 3-4) was seen in 31.0% (9/29) of cases with EC or EIN compared with 12.8% (220/1716) of those with a benign outcome (difference, +18.2% (95% CI, -0.5% to +36.9%)). Multiple multifocal vessels were recorded in 24.1% (7/29) women with EC or EIN vs 4.0% (68/1716) of those with a benign outcome (difference, +20.2% (95% CI, +4.6% to +35.7%)). A regular endometrial-myometrial junction was seen less frequently in women with EC or EIN (19/29 (65.5%)) vs those with a benign outcome (1412/1716 (82.3%)) (difference, -16.8% (95% CI, -34.2% to +0.6%)). In women with endometrial polyps without AUB, a single dominant vessel was the most frequent vascular pattern (666/1028 (64.8%)). In women with EC, both in those with and those without AUB, the endometrium usually manifested heterogeneous echogenicity, but the endometrium was on average 8.6 mm (95% CI, 5.2-12.0 mm) thinner and less intensely vascularized (color score 3-4: difference, -26.8% (95% CI, -52.2% to -1.3%)) in women without compared to those with AUB. In both pre- and postmenopausal women, asymptomatic endometrial polyps were associated with a thinner endometrium, and they manifested more frequently a bright edge, a regular endometrial-myometrial junction and a single dominant vessel than did polyps in symptomatic women, and they were less intensely vascularized. We describe the typical ultrasound features of EC, polyps and other intracavitary histologies using IETA terminology in women without AUB. Our findings suggest that the presence of asymptomatic polyps or endometrial malignancy may be accompanied by thinner and less intensely vascularized endometria than their symptomatic counterparts. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.

O-026 RCT of INTRA - Uterine administration of granulocyte colony-stimulating factor (G-CSF) before embryo-transfer in resistant thin endometrium in IVF-ICSI cycles

Abstract Study question Does intrauterine administration of G-CSF (granulocyte-colony-stimulating factor) prior to Embryo-Transfer in patients with resistant thin endometrium improve endometrial thickness and pregnancy rate in IVF-ICSI cycles? Summary answer Yes, Intrauterine administration of G-CSF(granulocyte colony-stimulating factor) before embryo transfer in resistant thin endometrium increases endometrial thickness and improves the pregnancy-rate in IVF-ICSI cycles. What is known already Optimal endometrial thickness reflects adequate maturation, which is a key factor for implantation. Proliferative and secretory changes at the endometrial lining are the result of a complex intrauterine environment where sex steroid hormones and local factors play important role. Lucena et al. found that the uterine-infusion of G-CSF increased endometrial thickness resulting in a successful pregnancy . Li et al. evaluated the effectiveness of G-CSF in a thin endometrium in frozen ET-cycles. The implantation and pregnancy rates were significantly higher (Scarpellini &amp; Sbracia 2012,et al.2015), whereas did not affect endometrial thickness, implantation, or pregnancy rates (Barad et al. 2014, Li et al. 2014). Study design, size, duration 86 Infertile patients with thin endometrium below 45 years age (2018 to 2021) were included in this study, in whom traditional treatment with estradiol, sildenafil etc had been unsuccessful. Patients were randomly divided into two groups using computer generated list after proper consent .The study group received intrauterine- G-CSF and control group received placebo (saline) before Embryo Transfer in IVF-ICSI cycles. Primary Outcome Endometrial-thickness, Implantation &amp; Pregnancy rates. Secondary-outcome Abortion-rate Participants/materials, setting, methods The study group (n = 43) received intrauterine infusion of 300 microgramme/1ml of G-CSF, and the control group (n = 43) underwent placebo-saline infusion before Embryo-Transfer. G-CSF was administered by an intrauterine catheter by slow instillation on the day of hCG administration. If the endometrium had not reached at least a 7-mm within 48 h, a second dose was administered following oocyte retrieval. Main results and the role of chance The endometrial growth was significantly different in the two groups, with an improvement in the G-CSF group. Endometrial expansion to Optimal thickness occurred within approximately 48 -72 hour after G-CSF instillation. In all subjects, at the time of administration of G-CSF, endometrial thickness was 6.43 ± 1.49 mm, and,after G-CSF administration, it increased significantly to 8.11 ± 1.42 mm. The IR and PR were statistically significantly higher in the group receiving intrauterine G-CSF (22% and 33%, respectively) as compared to the control group (08% and 14%, respectively). Abortion Rates were comparable in both the groups and difference was not significant. Endometrial instillation of G-CSF may be effective in expanding chronically unresponsive thin endometrium, resistant to conventional remedies. This treatment needs more multicentric trials to assess its potential in improving the implantation chances in IVF-ICSI cycles, thereby improving pregnancy rates. Uterine perfusion or SC injection with G-CSF represents a promising new tool for intractable problem of thin endometrium . Proliferative and secretory changes in the endometrial lining are the result of a complex intrauterine environment where sex steroid hormones and different local factors play an important role for endometrial thickening. Limitations, reasons for caution Our study is not without limitations. We did not have a large number of patients. The main strengths of study were its RCT design to evaluate the efficacy of intrauterine G-CSF administration on IVF success. Further more RCT are required to establish the best route and dose of GCSF administration in thin-endometrium. Wider implications of the findings Several methods have been proposed, to increase endometrial-thickness in women undergoing IVF-ICSI . These therapies included -tocopherol, pentoxifylline, low-dose aspirin, sildenafil citrate, estradiol administration and hCG priming.Our study using Intra-Uterine instillation of G-CSF represents a promising and cost-effective therapy for the currently most intractable problem of resistant, thin endometrium. Trial registration number not applicable

Receptivity at different endometrial thickness in women of reproductive age (literature review)

Overcoming infertility and reducing miscarriage are important challenges in obstetrics and gynecology. In the Russian Federation, the frequency of infertile couples reaches 24%; the percentage of miscarriage does not decrease, accounting for up to 20% of all desired pregnancies. The endometrial factor plays an important role in the causes of gravidar losses. Inadequate phase transformation of the endometrium is a predictor of fetal egg implantation failures. An integral part of endometrial cyclic transformations is the full proliferation of the mucous membrane of the uterine body. However, there is a cohort of women who, due to the insufficiency of proliferative processes in the endometrium, have a syndrome of thin endometrium. The pathogenesis of the formation of a hypoplastic endometrium in women with normal characteristics of hormonal factors is still poorly understood. Particular attention is paid to determining the function of proteomic markers (leukemia inhibiting factor, Forkhead box-protein family, etc.) in the genesis of the hypoplastic endometrium. This review presents an analysis of modern Russian and foreign sources on the receptivity of the endometrium, including the syndrome of thin endometrium in women of reproductive age.

Influence of parity and Body Mass Index (BMI) on endometry thickness variation in women of Lokossa, Benin

The thickness of the endometrium is also an important parameter in the clinical management of women. It is often influenced by several parameters which are important to determine. This is why the present study looked at the factors that influence the variation in the thickness of the endometrium of women in Lokossa in the Republic of Benin. This descriptive, prospective and cross-sectional study concerns 166 women aged 15 to 40 in Lokossa. Ultrasound examination measured the thickness of the endometrium on the longitudinal section through the suprapubic route. Anthropometric parameters were taken by other equipment from each woman. Analysis of one-way proc glm ANOVA variants and Student-Newman-Keuls (SNK) tests identified factors associated with variation in endometrial thickness in women. At the end of the study, the minimum, average and maximum values ​​of the thickness of the endometrium obtained are respectively Vm = 3.50 mm, VMoy = 6.73 ± 1.38 mm, MV = 10.00 mm during the pre-ovulatory phase, Vm = 7.30 mm, MV avg = 10.75 ± 2.11 mm, MV = 16.00 mm during the post-ovulatory period. There is an association between the thickness of the endometrium and parameters such as age, weight, Body Mass Index, parity. BMI has been found to be associated with changes in endometrial thickness. And this variation in the thickness of the endometrium of the woman's uterus is related to the number of deliveries. Thus, the higher the number of childbirth, the greater the thickness of the endometrium deprived.

SEVERITY OF INTRAUTERINE ADHESIONS AT TIME OF SURGERY AND NOT THE ENDOMETRIAL THICKNESS PRIOR TO SUBSEQUENT CYCLE DETERMINES CLINICAL PREGNANCY RATE

To determine if peak endometrial thickness in women undergoing assisted reproductive technologies (ART) with a diagnosis of intrauterine adhesions (IUAs) is associated with odds of achieving a clinical pregnancy.

The Effectiveness of Letrozole Adjuvant Therapy - Electro Acupuncture in Reducing the Number of Follicles and Body Weight and Increasing Endometrial Thickness in Women with Polycystic Ovary Syndrome

Background: Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age. Acupuncture can improve menstrual cycle recovery and decrease body mass index (BMI) in women with PCOS. The effect of acupuncture can be enhanced by giving letrozol. Researchers are interested in knowing the comparison between letrozol therapy with letrozol + electroacupuncture on body weight, follicle count, and endometrial thickness in women with polycystic ovary syn­drome. This study aims to determine the diffe­rences in weight loss, follicle number, and endometrial thickness in PCOS patients receiving letrozol treatment compared to letrozol + electroacupuncture. Subjects and Method: An observational ana­lytic study using a case-control approach and fixed disease sampling technique was carried out at the Gynecology Polyclinic and Sekar Clinic at Dr Moewardi Hospital, Sura­karta. Group 1 consisted of 15 infertile SOPK women who received letrozol and group 2 consisted of 15 infertile SOPK women who received electro­acupuncture + letrozol. Body weight, follicle count, and endometrial thick­ness were measured in both groups. Data were analyzed univariate, bivariate and multivariate using the IBM-SPSS version 22 and STATA version 13 statistical applications. Results: There was a significant difference in the thickness of the endometrium (p= 0.008), the number of follicles on day 6 (p= 0.039), the number of follicles on day 8 (p= 0.033), the number of follicles on day 10 (p= 0.041), the number of follicles on day 12 (p= 0.041) ) with letrozol therapy with letrozol + electroacupunc­ture. There was no significant difference in body weight between groups Conclusion: There were significant diffe­ren­ces between the letrozol group compared to the letrozol + electroacupuncture group in endo­metrial thickness and on the number of follicles on days 6, 8, 10, 12 in infertile PCOS women. However, there was no significant difference in body weight between groups. Keywords: number of follicles, endometrial thickness, PCOS, letrozol, electroacupuncture Correspondence: Todung Antony Wesliaprilius. Department of Obstetrics and Gynecology, Faculty of Medi­cine, Universitas Sebelas Maret/ Dr. Moewardi hospital, Surakarta. Mobile: 08222181626 Email: todungtobing@gmail.com. Journal of Maternal and Child Health (2021), 06(02): 219-228 https://doi.org/10.26911/thejmch.2021.06.02.09

Intrauterine administration of platelet-rich plasma improves embryo implantation by increasing the endometrial thickness in women with repeated implantation failure: A single-arm self-controlled trial.

PurposeThe purpose of this study was to investigate the effectiveness of intrauterine administration of platelet‐rich plasma (PRP) in frozen embryo transfer (FET) cycle in Japanese patients with a thin endometrium.MethodA prospective single‐arm self‐controlled trial was conducted in Japan. PRP administration was performed in 36 of the 39 eligible patients with a thin endometrium (≤7 mm). Hormone replacement therapy (HRT) with estrogen was performed for 2 menstrual cycles, and PRP was administrated on the 10th and 12th days of the second HRT cycle. The endometrial thickness was evaluated on transvaginal ultrasonography by two physicians at every visit, one an attending physician and the other a specialist physician blinded to the date and timing of the sonography. FET was performed during the second HRT cycle after PRP administration.ResultsAfter PRP administration, the mean (SD) endometrial thickness on the 14th day was significantly increased by 1.27 mm (P < .001) and 0.72 mm (P = .001) on the basis of the unblinded and blinded measurements, respectively. Of the 36 patients, 32 (88.9%) underwent FET. The clinical pregnancy rate was 15.6%. No adverse events occurred.ConclusionsPRP therapy was safe and effective in increasing endometrial thickness improving possibly pregnancy rate.

Endometrial assessment by transvaginal ultrasonography and correlation with histopathology among post menopausal women

Background: Transvaginal ultrasonography has increased the reliability of imaging diagnosis of women with endometrial pathologies and this technique has become widely used to evaluate endometrial thickness in women with postmenopausal bleeding.&#x0D; Materials and methods: 359 women presenting with history of at least three months amenorrhea were undergone transvaginal ultrasonography with measurement of endometrial thickness and uterine size. Endometrial biopsies were taken in 69 cases (19.2%) only.&#x0D; Results: The median age of patients was 53 years with the age range of 42 years to 81 years. Abdominal pain was the commonest symptoms followed by backache. 3/69 cases with histopathological diagnoses had normal sized uterus, while 66 cases had bulky (&gt;6.0 cm) uterus. 58/69 cases showed &gt; 5 mm thick endometrium and the endometrium was abnormal in 31/69 cases. The sensitivity, specificity, positive predictive value and negative predictive value of transvaginal ultrasonography to detect abnormal endometrium were 91.2%, 22.9%, 53.4% and 72.7% respectively. The sensitivity, specificity, positive predictive value and negative predictive value of transvaginal ultrasonography to detect endometrial hyperplasia and carcinoma were 100%, 17.5%, 10.3% and 100% respectively.&#x0D; Conclusions: Transvaginal sonographic evaluation of endometrial thickness and uterine size is useful for exclusion of endometrial pathology and to avoid unnecessary invasive surgical procedures.

Endometrial thickness as a biomarker for ongoing pregnancy in IUI for unexplained subfertility: a secondary analysis.

STUDY QUESTIONWhat is, in couples with unexplained subfertility undergoing IUI, the impact of gonadotrophins compared to clomiphene citrate (CC) on endometrial thickness (EMT) in relation to ongoing pregnancy?SUMMARY ANSWERIn women with unexplained subfertility undergoing IUI with ovarian stimulation, gonadotrophins lead to a thicker endometrium compared to CC, but this does not affect ongoing pregnancy rates.WHAT IS KNOWN ALREADYA systematic review and meta-analysis among couples with unexplained subfertility undergoing IUI with ovarian stimulation showed that women who conceived had, on average, a thicker endometrium than women who did not conceive, but this evidence is not robust due to a high level of heterogeneity. There was insufficient data to draw any conclusions on EMT and the effect on pregnancy outcomes.STUDY DESIGN, SIZE, DURATIONWe performed a secondary analysis of a multicentre randomized controlled superiority trial in couples with unexplained subfertility undergoing IUI with adherence to strict cancellation criteria. In total, 738 couples recruited between July 2013 and March 2016 were allocated to ovarian stimulation with gonadotrophins (n = 369) or with CC (n = 369) for a maximum of four IUI cycles. According to local protocol, recombinant FSH, urinary FSH or hMG was used. Natural conceptions and cancelled cycles were removed from this secondary analysis, as they do not provide any information on pregnancy in relation to stimulation after IUI. Ongoing pregnancy was defined as a positive heartbeat at or beyond 12 weeks of gestation.PARTICIPANTS/MATERIALS, SETTING, METHODSWe first determined the difference in EMT between women randomized to gonadotrophins (75 IU) and CC (100 mg) over all cycles using a linear mixed model. We then investigated the association between EMT and ongoing pregnancy after IUI using a logistic regression model, adjusted for the allocated drug, number of dominant follicles, female age, BMI, duration of subfertility, primary or secondary subfertility, referral status, smoking status, cycle number and total motile sperm count. To conclude, we investigated the association between EMT and ongoing pregnancy by logistic regression separately in women allocated to gonadotrophins and in women allocated to CC.MAIN RESULTS AND THE ROLE OF CHANCEA total of 666 couples underwent 1968 IUI cycles. Of these, 330 couples were allocated to gonadotrophins, of which 85 conceived leading to ongoing pregnancy (rate per cycle 8.9%) and 336 couples were allocated to CC, of which 71 conceived leading to ongoing pregnancy (rate per cycle 7.0%) (relative risk (RR) 1.22, 95% CI 0.92 to 1.61). The mean EMT was 8.9 mm (SD 2.1) in women treated with gonadotrophins and 7.5 mm (SD 2.1) in women treated with CC (adjusted mean difference 1.4 mm; 95% CI: 1.1–1.7). The overall mean EMT was 8.4 mm (SD 2.2) in women that conceived leading to ongoing pregnancy and 8.2 mm (SD 2.2) in women that did not conceive (adjusted odds ratio (OR): 1.03 per 1 mm increase, 95% CI 0.95–1.12). There was no association between EMT and ongoing pregnancy in women treated with gonadotrophins or CC (OR: 1.01 per 1 mm increase, 95% CI 0.90–1.13, and 1.10 per 1 mm increase, 95% CI 0.99–1.23, respectively).LIMITATIONS, REASON FOR CAUTIONSince this is a secondary analysis, the data should be interpreted prudently as secondary analyses are prone to false-positive findings or could be underpowered to show associations that the study is not primarily set up for.WIDER IMPLICATIONS OF THE FINDINGSIn women with unexplained subfertility and treated with IUI, gonadotrophins lead to a significantly thicker endometrium compared to CC, but there was no evidence of a consistent association between EMT in women treated with gonadotrophins or CC and the ongoing pregnancy rate. A relatively thin endometrium after CC is therefore not a valid reason to prefer gonadotrophins as the stimulation agent in IUI for unexplained subfertility.STUDY FUNDING/COMPETING INTEREST(S)The initial trial was funded by the Netherlands Organization for Health Research and Development (ZonMw) (Health Care Efficiency Research; project number: 80-83600-98-10 192). The EudraCT number for this trial was 2013-001034-18. Prof. Dr B.W.J.M. is supported by a NHMRC Practitioner Fellowship (GNT1082548). B.W.M. reports consultancy for Merck, ObsEva and Guerbet. The other authors declare no conflicts of interest.TRIAL REGISTRATION NUMBERNTR 4057

Effect of vaginal estrogen cream on endometrial thickness in women under embryo transfer by applying long protocol method

Background and aims: Endometrial thickness (ET) is one of the main parameters in the success of assisted reproductive technology (ART) methods, which is influenced by sex steroids. This study investigated the effect of vaginal estrogen cream on ET in women undergoing embryo transfer. Methods: In this clinical trial, 100 infertile women candidates for embryo-fetal transfusion were enrolled in the study by a simple sampling method and then randomly divided into two treatment groups. For patients in group A, estradiol tablets were administered alone (control) and group B received the estradiol plus vaginal estrogen cream (intervention). The thickness of the endometrium was measured by ultrasound in both groups and recorded in the checklist. The rate of positive bHCG, pregnancy, and canceled cycles was evaluated in both groups as well. Finally, the data were analyzed using SPSS software. Results: Both groups were matched in terms of age (P=0.129). There was no significant difference between the groups regarding ET (P=0.651) and bHCG frequency (P=0.418) and the pregnancy rate was similar in two groups. Based on the results, the frequency of the canceled cycles was 32% and 50% in intervention and control groups (P=0.031).Eventually, no significant relationship was observed between pregnancy outcome (0.637) and the bHCG (0.553) test with ET. Conclusion: Overall, the administration of vaginal estrogen cream has no effect on ET and pregnancy rate in women under embryo transfer by applying the long protocol method in patients who referred to endometrium and endometriosis research center but it significantly reduces the eliminated cycles

Association of mental health diagnoses and uterine endometrial thickness in women undergoing in-vitro fertilization

To assess the association between mental health diagnoses and uterine receptivity, operationalized as endometrial thickness. Due to the lack of data regarding the impact of mental health diagnoses on intermediate outcomes of in vitro fertilization (IVF), we performed an exploratory retrospective cohort study of women undergoing IVF at an academic medical center from 2018 to 2019. A total of 101 patients undergoing IVF were recruited and underwent controlled ovarian hyperstimulation with an antagonist protocol. Women on clomiphene or letrozole, those seeking fertility preservation and those with uterine factor were excluded. Mental health diagnoses and medications were abstracted from chart review. Endometrial thickness was assessed via transvaginal ultrasound on the final day of stimulation. We used linear regressions to assess the associations between 1) anxiety 2) depression 3) any psychiatric diagnosis 4) current treatment with antidepressant or anxiolytic medications. Of the 101 women, 12 (11.9%) had previously been diagnosed with anxiety, 10 (9.9%) had been diagnosed with depression, of these women 15 (14.9%) were currently being treated with antidepressants or anxiolytic medications. Women had a mean of 35.1±4.0 years of age, a mean BMI of 26.3±5.6 kg/m2, and a mean endometrial thickness of 10.3±2.7 mm. Women self-reported as Caucasian (52.5%), Asian (24.8%), or African American (15.8%). A mental health diagnosis (p=.01) and use of antidepressants or anxiolytic medications (p=.002) were negatively associated with endometrial thickness. All associations remained significant after controlling for BMI. Endometrial thickness was not associated with cycle characteristics (peak estradiol level, total gonadotropin dose, or number of oocytes retrieved). Mental health diagnoses and current antidepressant or anxiolytic treatment are associated with a thinner endometrial thickness, a marker of uterine receptivity. Prior studies have indicated women with history of anxiety and depression may have lower live birth rates; this is perhaps due to the influence of stress on endometrial thickness and interaction with the reproductive hormonal axis. These findings are important given the strong association of mental health diagnoses and infertility, with anxiety and depression often exacerbated by the stress of fertility treatment. Future studies will examine biochemical markers of stress to further explore the mechanism behind this finding.

HORMONAL SUPPORT OF ENDOMETRIUM IN IVF CYCLES WITH VITRIFIED EUPLOID BLASTOCYST TRANSFER

A total of 100 women with tubal-peritoneal infertility, that were divided into 2 groups, 50 people each, were examined. In the first group, vitrified embryo transfer was carried out in the natural menstrual cycle with minimal LP support. The second group included patients, who underwent endometrial hormonal preparation and LP maintenance. Analysis of the efficiency of embryo transfer (ET) in the cryocycle showed that after the endometrium prepa ration was performed with hormonal preparations (group II) on the ET day, the thickness and structure of the endometrium normalized and practically did not differ from the endometrial thickness in women in the natural menstrual cycle with minimal LF support (I Group). A slight decrease in vascular resistance indices of uterine blood flow during hormonal preparation of the endometrium, compared with the natural cycle, indicates a posi tive effect of hormonal therapy on the structure and function of the endometrium. The results of the analysis of protocols with hormonal preparation of the endometrium and transfer of thawed embryos in the natural menstrual cycle showed the same efficiency in terms of the frequency of preg nancy.

Effect of hysteroscopic lysis of intrauterine adhesions in menstruating women on subsequent late proliferative phase endometrial thickness

Purpose: To determine if adhesiolysis of intrauterine adhesions improves or is detrimental to post-operative endometrial thickness in women with normal menstruation. Materials and Methods: Endometrial thickness by sonography was determined at the time of the mature dominant follicle, both in a cycle prior and then following hysteroscopic adhesiolysis. Results: The pre- and post-average endometrial thicknesses were exactly the same. Considering three endometrial thickness categories (4-5 mm poor prognosis, 5-6 mm fair prognosis,and ≥ 8 good prognosis) one woman went from fair to good, but three went from good to fair, and one went from good to poor. Conclusions: Through there were no significant differences, but there was a trend for diminished endometrial thickness. Thin endometria has been associated with diminished fecundity. This preliminary study should encourage a large prospective controlled study evaluating the effect of adhesiolysis on endometrial thickness and pregnancy rates in women with normal menses despite intrauterine adhesions.

A prospective observational study of the follow-up of medical management of early pregnancy failure.

Background:Medical termination for missed miscarriage with the use of 800 μg of vaginal misoprostol as a single agent is recommended as a cheap option before 14 weeks of gestation in developing countries. A few studies have looked at its efficacy.Methods:A prospective, observational study was done on women having medical termination with up to three doses of 800 μg vaginal misoprostol at 12 hourly intervals. The number of women who needed check curettage was collected. Ultrasound findings if done were collated. Follow-up was done telephonically at the end of first week, fourth week and sixth week.Results:The cohort comprised 145 women. The primary outcome was the need for curettage after expulsion of products following medical management and this was 49/145 (37.8%) of women. The induction expulsion interval was 36 hours. The mean endometrial thickness of the 113/145 women who had an ultrasound was 11 mm. The mean endometrial thickness in women who had check curettage was 18 mm. Persistent spotting was the only significant symptom at follow-up. Resumption of cycle at the end of the sixth week was seen in 105/132 (80.15%) of women who were followed up.Conclusion:Findings of our study showed the check curettage rate of 37.8%. However, the regime which we used, that is, 800 μg vaginal misoprostol at 12 hourly intervals had a long induction to expulsion interval of 36 hours. In all, 80% of women resumed normal cycles at the end of the sixth week. No significant complications were noted on follow-up.

A pilot study of levonorgestrel concentrations and bleeding patterns in women with epilepsy using a levonorgestrel IUD and treated with antiepileptic drugs

ObjectivesWe explored levonorgestrel (LNG) concentrations, bleeding patterns and endometrial thickness in women with epilepsy (WWE) initiating an LNG-intrauterine device (IUD) co-administered with antiepileptic drugs (AEDs). Study designThis pilot study included 20 WWE ages 18 to 45 years with well-controlled seizures and stable AED regimens initiating a 52-mg LNG-IUD (20 mcg/d initial release). We collected blood and measured endometrial thickness before IUD placement and 21 days, 3 months and 6 months thereafter. Participants recorded bleeding/spotting daily. We measured total LNG (radioimmunoassay), serum hormone binding globulin (SHBG, immunoassay) and calculated the free LNG index. We compared total LNG, free LNG index, SHBG and endometrial thickness over time using a linear mixed-effects model. ResultsTotal LNG, free LNG index and SBHG levels remained stable from day 21 throughout. Endometrial thickness decreased from a median of 5.9 mm [interquartile range (IQR) 4.6–7.5] at day 21 to 3.3mm (2.8–4.9) by month 6 (p=0.02). Bleeding and spotting days decreased from a median of 16 (IQR 13–23) in month 1 to 6.5 (IQR 4–8.5) in month 6 regardless of AED regimen. ConclusionLike women without epilepsy, WWE initiating the LNG-IUD experience stable total LNG concentrations and decreasing endometrial thickness and bleeding over the first 6 months of use. ImplicationsLike women without epilepsy, WWE using antiepileptic drugs can expect a stable LNG concentration and decreasing bleeding during the first 6 months of LNG-IUD use. Our data can be useful for guidance of WWE considering use the LNG-IUD.

Endometrial Thickness in Women Undergoing IUI With Ovarian Stimulation. How Thick Is Too Thin? A Systematic Review and Meta-analysis

(Abstracted from Hum Reprod 2017;32:1009–1018) A simple, noninvasive first-line treatment for women diagnosed as having unexplained or mild male subfertility is intrauterine insemination with ovarian stimulation (IUI-OS). The drugs most frequently used for OS are antiestrogens, such as clomiphene citrate (CC), aromatase inhibitors, or gonodotrophins.