Midcycle Endometrial Thickness Research Articles

Antimüllerian hormone and endometrial thickness in predicting xfollicular maturation in patients with polycystic ovary syndrome

Polycystic ovary syndrome is an anovulatory infertility problem that requires the treatment of ovulation induction. Clomiphene citrate is a first-line regimen for ovulation induction. The antimüllerian hormone is produced by granulosa cells of small, growing follicles in the ovary. Folliculogenesis is an essential process for ovarian function. Endometrial thickness is important throughout a female's life, especially concerning medications for ovulation induction. This study aimed to determine the role of basal antimüllerian hormone and midcycle endometrial thickness in predicting follicular maturation and pregnancy in patients with polycystic ovary syndrome treated with clomiphene citrate. This was a prospective cohort study that was conducted at El-sir Abualhassan's Fertility Center (September 2020 to August 2021). The study included 197 patients with polycystic ovary syndrome diagnosed using the Rotterdam criteria. The patients were treated with a dosage of 100 mg of clomiphene citrate. Data were collected using a questionnaire that was filled out after informed consent was provided by the patients. The basal antimüllerian hormone level was measured using enzyme immunoassay, and endometrial thickness and follicular size were measured before and after clomiphene citrate treatment using transvaginal ultrasound. The data were analyzed using SPSS (version 23; IBM Corporation, Armonk, NY). Moreover, the correlation was performed using the chi-square test. Almost two-thirds of the participants have normal antimüllerian hormone levels. Before clomiphene citrate was used as the treatment regimen, 95.40% of the patients had an endometrial thickness of ≤5 mm and a follicular size of 1 to 6 mm. After clomiphene citrate treatment, 74.60% of the patients had an endometrial thickness of 6 to 10 mm, and 46.20% of the patients had a follicular size of 7 to 12 mm. A significant correlation was found between basal antimüllerian hormone, follicular maturation, and pregnancy (P=.001). There was a significant association between endometrial thickness after clomiphene citrate treatment and achieving pregnancy (P=.001). Clomiphene citrate is a first-line regimen for patients with polycystic ovary syndrome with normal antimüllerian hormone levels. After clomiphene citrate treatment, there was a correlation between antimüllerian hormone and follicular maturation and pregnancy. Moreover, there was a correlation between midcycle endometrial thickness and pregnancy.

Factors associated with clinical outcome in an embryo recipient cycle at a public In-vitro fertilization centre

Background: Several factors influence the outcome of embryo recipient cycles. Knowledge of these factors will help in patient care.Objective: To determine factors associated with outcome in embryo recipient cycles.Materials and Methods: A retrospective analysis of all embryo recipient cycles from January 2015 to December 2017 in public tertiary hospital based assisted reproductive program. Primary outcome measure was clinical pregnancy. Comparative analysis of baseline demographic and clinical/treatment variables was made between cycles that resulted in clinical pregnancy and those that did not.Results: Overall 155 embryo recipient cycles were reviewed and there were 52 clinical pregnancies [33.5%]. The mean age was 42.9± 4.3. The mean age, type and duration of infertility did not influence the cycle outcome. The mean endometrial thickness did not differ significantly between the two groups [9.2±1.5 vs 8.8±1.9], but pregnancy rate was higher with endometrial lining greater than ≥8mm (OR 0.36, p =0.02). Good quality embryos 37% (50/135) resulted in more clinical compared to poor ones 10% (2/20), ( OR 5.29 p= 0.016). Over 70% of embryo transfer process was easy. The pregnancy rate was significantly higher with easy transfer 38.4% (43/112) compared to 20.9% (9/43) of difficult transfers, (P=0.039, OR, 2.35; 95%Cl 1.03-5.59).Conclusion: Embryo quality and transfer difficulties are principal determinants of outcome in embryo recipient cycles. Recipients’ midcycle endometrial thickness of at least 8mm may positively influence cycle outcome. Therefore, these factors must be fully evaluated and optimized before treatment is initiated.

ROLE OF 2D DOPPLER ULTRASOUND ON THE DAY OF EMBRYO TRANSFER IN PREDICTING PREGNANCY IN ICSI

Background: Endometrium examination by Ultrasound is commonly used to assess the endometrial receptivity during in vitro fertilization (IVF) treatment. Aim of the work: To evaluate the role of pulsatility index (PI) of uterine artery blood flow during IVF-ET cycles in prediction of pregnancy rate. Patients & Methods: A prospective study was conducted atMaternity Hospital of Ain Shams University in cooperation with the department of Radiodiagnosis. It included 400 females, diagnosed as infertility for ICSI (Intracytoplasmic sperm injection) trial. The uterine artery parameters (PI & RI) and endometrial thickness were measured by 2D Doppler ultrasound on the day of embryo transfer. ICSI_ET led to 193 clinical pregnancies with multiple pregnancies in 38 cases. The pregnancy rate was 48.25% with application of the Gonadotropin-releasing hormone (GnRH) long protocol, and the implantation rate was 30% of (N=120 cases). The 193 intrauterinepregnancies were classified as the pregnant group (P); the other 207 cases were classified as the non pregnant group (NP). Results: There was statistically significant difference as regards pregnancy outcome in the sub-endometrial blood flow PI (p value 0.01) which is lower in pregnant group (P) than non pregnant ones (NP). However there was no statistically significant difference as regards the mean midcycle endometrial thickness in pregnant group (P) were 11.35 and that of non pregnant group (NP) was 10.8 with P value (0. 62). Conclusion: Midluteal phase of females with unexplained infertility have been shown to be of some value in predicting pregnancy rates.

Impact of letrozole on ultrasonographic markers of endometrial receptivity in polycystic ovary syndrome women with poor endometrial response to clomiphene citrate despite adequate ovulation

Abstract Objectives To investigate the endometrial effects of letrozole in PCOS women with poor endometrial response (endometrium thickness ⩽7 mm) to clomiphene citrate (CC) despite adequate ovulation, using the ultrasonographic markers of endometrial receptivity. Study design Ambidirectional cohort study. Patients and methods Sixty women with anovulatory PCOS having endometrial thickness less than 7 mm despite adequate ovulation with CC underwent ovulation induction with Letrozole (5 mg/day from cycle day 3 to 7) for one treatment cycle. Main outcome measures: Comparison of the endometrial thickness (ET) and pattern, uterine artery and spiral artery, resistance index (RI) and pulsatility index (PI) between the current letrozole and previous CC stimulated cycles. Results In the current letrozole cycle compared with the previous CC cycles, there were significantly greater midcycle endometrial thickness (8.97 ± 1.32 vs. 5.7 ± 1.2, respectively; P P P Conclusion Letrozole is an effective second-line treatment in women with inadequate endometrial response to CC, as letrozole increased endometrial thickness trilaminar pattern and improved endometrial perfusion.

A prospective randomized trial comparing the efficacy of Letrozole and Clomiphene citrate in induction of ovulation in polycystic ovarian syndrome

OBJECTIVES:To compare the efficacy of letrozole and clomiphene citrate (CC) in patients of anovulatory polycystic ovarian syndrome (PCOS) with infertility.MATERIALS AND METHODS:This prospective randomized clinical trial included 204 patients of PCOS. 98 patients (294 cycles) received 2.5–5 mg of letrozole; 106 patients (318 cycles) received 50–100 mg of CC (both orally from Days 3–7 of menstrual cycle). The treatment continued for three cycles in both the groups. Main outcome measures: ovulation rate, endometrial thickness, and pregnancy rate. Statistical analysis was done using SPSS 13 software. P value less than 0.05 was considered significant.RESULTS:The mean number of dominant follicles in letrozole groups and CC groups was 1.86±0.26 and 1.92±0.17, respectively (P=0.126). Number of ovulatory cycle in letrozole group was 196 (66.6%) versus 216 (67.9%) in CC group (P=0.712). The mean mid-cycle endometrial thickness was 9.1±0.3 mm in letrozole group and 6.3±1.1 in CC group, which was statistically significant (P=0.014). The mean Estradiol [E2] level in clomiphene citrate group was significantly higher in CC group (364.2±71.4 pg/mL) than letrozole group (248.2± 42.2 pg/mL). 43 patients from the letrozole group (43.8%) and 28 patients from the CC group (26.4%) became pregnant.CONCLUSION:Letrozole and CC have comparable ovulation rate. The effect of letrozole showed a better endometrial response and pregnancy rate compared with CC.

Laparoscopic ovarian diathermy after clomiphene failure in polycystic ovary syndrome: is it worthwhile? A randomized controlled trial.

Laparoscopic ovarian diathermy (LOD) represents a successful treatment option for women with clomiphene citrate (CC)-resistant polycystic ovary syndrome (PCOS). However, in case of CC failure PCOS, LOD offers several theoretical advantages. This study was conducted to compare the efficacy of LOD versus continuation of CC up to six further cycles in PCOS patients who failed to achieve pregnancy despite the previous successful CC induced ovulation. One hundred and seventy six infertile women with CC failure PCOS were selected in this randomized controlled trial. Patients (n = 87) underwent LOD with 6 months follow-up or received CC (n = 89) up to six cycles. Outcome measures were; clinical pregnancy rate, midcycle endometrial thickness, cycle length, miscarriage and live birth rates. The clinical pregnancy rate per patient and the cumulative pregnancy rate after six cycles were comparable in both groups (39 vs. 33.7% and 47 vs. 39.2%, respectively). Four twin pregnancies occurred in CC group and none in LOD group and the difference was statistically significant (p < 0.05). No significant difference in midcycle endometrial thickness was observed (8.8 ± 1.2 mm vs. 7.7 ± 1.1 mm). Improvement in cycle length, miscarriage and live birth rates were comparable in both groups. No cases of ovarian hyperstimulation syndrome occurred in either group. LOD during the 6 months follow-up period and CC for up to six further cycles are equally effective for achieving pregnancy in CC failure PCOS patients.

Combined metformin and clomiphene citrate versus laparoscopic ovarian diathermy for ovulation induction in clomiphene‐resistant women with polycystic ovary syndrome: A randomized controlled trial

To compare the effect of combined metformin and clomiphene citrate (CC) with laparoscopic ovarian diathermy (LOD) meant for ovulation induction in CC-resistant women with polycystic ovary syndrome (PCOS). Two-hundred and eighty-two anovulatory women with CC-resistant PCOS were selected in this randomized controlled trial. Patients (n = 138) received combined metformin-CC for up to six cycles or underwent LOD (n = 144) with six months follow up. The outcome measures were: ovulation rate, midcycle endometrial thickness, pregnancy and miscarriage rates. Ovulation occurred in 386/576 cycles (67%) in the combined metformin-CC group and 381/558 cycles (68.2%) in LOD group without a significant difference between the groups. Resumption of regular menstruation was similar in both groups. A significant increase in midcycle endometrial thickness was observed in the combined metformin-CC group (9.2 ± 1.2 mm vs 7.6 ± 1.1 mm) (P < 0.05). The pregnancy rate was similar in both groups (15.4% vs 17%), and there were no statistically significant differences regarding the miscarriage rate between both groups. Four twin pregnancies occurred in the metformin-CC group. No ovarian hyperstimulation occurred in either group. Combined metformin-CC and LOD are equally effective for inducing ovulation and achieving pregnancy in CC-resistant PCOS patients.

Endometrial effects of letrozole and clomiphene citrate in women with polycystic ovary syndrome using spiral artery Doppler

To compare the effects of letrozole and clomiphene citrate (CC) on endometrial response in PCOS using subendometrial spiral artery Doppler. Fifty consecutive patients of anovulatory PCOS were recruited. Twenty-five patients (58 cycles) received 2.5-5 mg of letrozole; 25 patients (56 cycles) received 50-100 mg of CC (both orally on days 5-9 of menses). number of dominant follicles, endometrial thickness (ET), spiral artery resistance index (RI) and pulsatility index (PI) and pregnancy rate. The mean number of dominant follicles in letrozole group and CC groups was 1.63+/-1.02 and 1.62+/-0.96, respectively (P>0.05). The mean mid cycle ET was 6.9+/-0.74 mm in letrozole group and 5.9+/-0.53 mm in CC group (P<0.05). In letrozole and CC groups, the mean RI of spiral artery were 0.63+/-0.05 and 0.79+/-0.09, respectively, and the mean PI of spiral artery were 1.19+/-0.06 and 1.55+/-0.13, respectively. Both RI and PI in the letrozole group showed significant lower impedance compared to CC group (P<0.05). Pregnancy rate per cycle was 19% (11/58) in the letrozole group and 12.5% (7/56) in the CC group (P>0.05). The effect of letrozole showed a significantly better endometrial response compared to CC.

Importance of Midcycle Endometrial Thickness for In Vitro Fertilization in the Improved Technology Era

Background: In the early 1990s several studies found a much lower pregnancy rate if the endometrial thickness on the day of human chorionic gonadotropin (hCG) injection was <10 mm. Improvements in technology have led to the formation of hardier embryos.

A Randomized Double-Blind Comparison of the Effects of Clomiphene Citrate and the Aromatase Inhibitor Letrozole on Ovulatory Function in Normal Women

Clomiphene citrate is an effective inducer of ovulation, but pregnancy rates per cycle remain comparatively low, possibly because of an antiestrogenic effect on the endometrium. Letrozole, a potent, orally active aromatase inhibitor, suppresses the production of estrone from androstenedione and has markedly increased gonadotropin levels in animal studies. A possible role of letrozole in ovulation induction was explored in a randomized, double-blind, pilot study enrolling 19 ovulatory women ranging in age from 18 to 35 years. After a natural cycle, the women received either 2.5 mg of letrozole or 50 mg of clomiphene citrate daily on days 5 to 9 after menstruation. Ovarian follicle formation was monitored by transvaginal ultrasonography. The major measure of outcome was the number of mature follicles measuring at least 18 mm at the time of the LH surge. In the 16 women completing both study cycles, a comparable increase in the number of mature follicles at the LH surge was noted in both treatment groups. The mean number was 2.2 with clomiphene therapy and 1.7 in women given letrozole. Midcycle endometrial thickness averaged 10.1 mm in the clomiphene group and 10.6 mm in the letrozole group during the treatment cycle, not a significant difference. All letrozole-treated women but fewer than 60% of those given clomiphene citrate had trilaminar pattern endometrium at midcycle in the natural cycle. The numbers did not drop significantly in either group during the treatment cycle. Follicular gonadotropin profiles were comparable in the two groups in both natural and medicated cycles. Estradiol levels in treatment cycles were higher with clomiphene and lower than those in natural cycles when letrozole was administered. Letrozole seems to be equivalent to clomiphene citrate for stimulating follicle growth in normally ovulating women. This agent may make women more sensitive to FSH, enhance endometrial development (compared with clomiphene), and increase implantation rates through more physiological estradiol levels. Letrozole should be a useful alternative to clomiphene citrate for ovarian hyperstimulation in both intrauterine insemination and in vitro fertilization.

Factors useful in predicting the success of oocyte donation: a 3-year retrospective analysis

Objective: To establish prognostic relevance of parameters assessed in oocyte donation cycles. Design: Retrospective analysis. Setting: Large university-based donor oocyte program. Patient(s): All oocyte recipient cycles achieving embryo transfer from September 1995 to October 1998. Intervention(s): None. Main Outcome Measure(s): Pregnancy. Result(s): Recipient age and reproductive status, day 9 and 12 serum estradiol (E 2) levels and a progesterone (P) level obtained 2 days after initiation of hormonal therapy did not correlate with pregnancy. Endometrial thickness, but not endometrial pattern, was useful in predicting pregnancy outcome. The clinical pregnancy and live-birth rate in cycles where the endometrial thickness was less than 8 mm was significantly lower when compared to cycles with an endometrial thickness ≥9 mm. Cycles where optimal quality embryos were transferred had the highest implantation (36%), clinical pregnancy (63%) and live birth (54%) rates and these rates were significantly higher than those of cycles where only poor quality embryos were available for transfer (10% implantation, 17% clinical pregnancy, and 8% live birth rates, respectively; P<.05). Conclusion(s): The most reliable predictive factors for pregnancy in oocyte donation cycles are the quality of the embryos transferred and the recipient’s mid-cycle endometrial thickness. Recipient monitoring should minimally include ultrasound assessment of endometrial thickness.

Relationship between serum CA 125 levels, endometrial thickness and corpus luteum function in different stages of ovarian activity.

CA 125 is a cell surface antigen expressed in some derivatives of celomic epithelium, predominantly in ovarian cancer cells. However, it has also been detected in serum of healthy women and in patients with benign gynecologic diseases. The exact source or sources of the circulating levels of CA 125 and their elevations are not known. In the present study, the relationship between serum CA 125 levels, ovarian steroidogenesis and endometrial thickness is investigated at different periods: 1) mid-follicular, 2) midcycle, and 3) midluteal phases in normal cycles of fertile women, in patients stimulated for intrauterine insemination (IUI) and in patients stimulated for in vitro fertilization (IVF). Only in patients with mild and moderate ovarian hyperstimulation (OHSS) of the IVF group were luteal phase CA 125 levels (149.7 +/- 24.4 U/ml) significantly higher than midfollicular (21.2 +/- 1.9 U/ml) and midcycle phase levels (24.4 +/- 2.5 U/ml) (p < 0.001). The mean midcycle estradiol and midluteal progesterone concentrations in patients stimulated for IUI and IVF were significantly higher than those of normally cycling women (p < 0.001). Mean endometrial thickness in patients stimulated for IVF was significantly higher than in patients stimulated for IUI and normally cycling women (p < 0.001). Midluteal CA 125 levels correlated with midcycle endometrial thickness (r = 0.585, p < 0.05) and midluteal P levels (r = 0.497, p < 0.05) in patients with OHSS of IVF group. This correlation was not observed in patients who had no signs and symptoms of OHSS during stimulation for IVF and in patient stimulated for IUI and the controls.(ABSTRACT TRUNCATED AT 250 WORDS)