Significant Difference In Endometrial Thickness Research Articles

Evaluating the effectiveness and adverse effects of oral versus transdermal estradiol for endometrial preparation in frozen-thawed embryo transfer: a randomized controlled trial

BackgroundEndometrial preparation significantly influences the success of embryo transfer procedures. Although both oral and transdermal estradiol are common methods for endometrial priming, their efficacy and potential side effects remain uncertain. This randomized controlled trial aims to compare the effectiveness of oral and transdermal estradiol in endometrial preparation, while also evaluating their respective side effects in patients undergoing assisted reproduction treatments.MethodThis randomized clinical trial (ISRCTN15301227) was conducted at Hung Vuong Hospital between July 2020 and March 2022. Among 550 eligible patients undergoing frozen embryo transfer cycles, we included 380 patients for the study. The study protocol and all materials received approval from the Ethics Committee of Hung Vuong Hospital (1315/CN-HĐĐĐ). Participants were randomly assigned to one of two groups: Group A (n =190) received oral estradiol at an initial dose of 4 mg per day for 7 days, with the dose increased according to clinical response. Group B (n =190) received transdermal estradiol at an initial dose of 2 measures of 2.5 g estradiol gel per day for 7 days, with the dose similarly increased according to clinical response. Treatment in both groups began on days 2–3 of the menstrual cycle, with the maximum duration of estradiol administration being 27 days. We compared estradiol levels on the day of progesterone administration, duration of treatment, total estradiol dose, endometrial thickness, pregnancy outcomes, and any observed side effects between the two groups.ResultsGroup A exhibited significantly higher estradiol levels on the day of progesterone administration compared to Group B (270.5 pg/ml versus 186.5 pg/ml, p < 0.001). However, the comparison revealed no significant difference in endometrial thickness between the two groups (10.5 mm versus 10.6 mm, p = 0.85). Furthermore, pregnancy rates including positive human chorionic gonadotropin, clinical pregnancy, ongoing pregnancy, live birth, and pregnancy failure were also found to be similar between the two groups. Notably, a greater proportion of patients in Group A experienced mild side effects compared to those in Group B (20.3% versus 10.1%, respectively; n =37 versus n =18), and this discrepancy was found to be statistically significant (p = 0.007).ConclusionTransdermal estradiol offers comparable endometrial thickness and pregnancy outcomes, along with improved patient compliance and fewer side effects compared to oral estradiol.

Comparative study between effect of both drugs Tamoxifen versus Letrozole on endometrial thickness as Hormonal adjuvant therapy in breast cancer

Background: Breast cancer is the most commonly diagnosed cancer and the second leading cause of cancer related death in women. About eighty percent of breast cancers express Estrogen receptors. Long term survival of hormone receptor positive breast cancer patients was significantly improved after introduction of adjuvant hormonal therapy. Different classes of hormonal agents with different mechanisms of action and side effects are available. Tamoxifen has known proliferative effect on endometrium. This may lead to hyperplasia, bleeding and endometrial cancer. Objective: to compare between effects of tamoxifen versus effect of letrozole on the endometrial thickness as adjuvant Endocrine treatment in hormone receptor positive breast cancer. Patients and methods: 66 patients were enrolled in the study from May 2021 to November 2021; they were randomized to receive either tamoxifen or letrozole. Endometrial thickness was measured at baseline, after three and six months from start of treatment. Results: No significant difference in endometrial thickness in the two groups.

The follicular-phase depot GnRH agonist protocol results in a higher live birth rate without discernible differences in luteal function and child health versus the daily mid-luteal GnRH agonist protocol: a single-centre, retrospective, propensity score matched cohort study

BackgroundThe gonadotropin-releasing hormone agonist (GnRH-a) has been used in in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) cycles for a long time. This paper evaluates the efficacy and safety of two commonly used protocols (follicular-phase depot GnRH-a protocol and daily mid-luteal long GnRH-a protocol) in normal responders undergoing IVF/ICSI using propensity score matching (PSM) analysis.MethodsA total of 6,816 infertile women treated within the period from January 2016 to September 2020 were stratified into cohorts. A total of 2,851 patients received the long-acting group (depot GnRH-a protocol), and 1,193 used the short-acting group (long GnRH-a protocol) after the data-selection process. PSM was utilized for sampling by up to 1:1 nearest neighbour matching to adjust the numerical difference and balance the confounders between groups. The primary outcome was the live birth rate (LBR). Multivariable logistic analysis was used to evaluate the difference between these two protocols in relation to the LBR.Result(s)In this study, 1:1 propensity score matching was performed to create a perfect match of 964 patients in each group. After matching, the blastocyst formation rates, oestradiol (E2) value on Day hCG + 9, progesterone (P) value on Day hCG + 9, implantation rates, clinical pregnancy rates, and LBR were more favourable in the depot GnRH-a protocol than in the long GnRH-a protocol (P < 0.05). However, the moderate or severe OHSS rates were higher in the depot group than in the long group (P < 0.001). There were no significant differences in endometrial thickness, luteal support medication, early pregnancy loss rates, mid- and late-term pregnancy loss rates, or foetal malformation rates between the two protocols.Conclusion(s)Compared with the daily short-acting GnRH agonist protocol, the follicular-phase depot GnRH-a protocol might improve LBRs in normogonadotropic women without discernible differences in luteal function and child health.

Effect of vaginal/oral tadalafil on endometrial thickness in IVF patients: a double-blind, placebo controlled RCT: a pilot study.

To investigate the effect of tadalafil (a long working phosphodiesterase type 5 inhibitor) on the endometrial thickness, biochemical pregnancy rates and clinical pregnancy rates in women in an in vitro fertilization treatment. This study investigates the use of vaginal and oral administration of tadalafil. This is a prospective double-blind placebo-controlled randomized controlled trial with 58 patients in an in vitro fertilization treatment with a short antagonist stimulation protocol. The study population is divided into three equal groups comparing oral and vaginal administration of tadalafil to a control group. No significant difference in endometrial thickness and number of biochemical and clinical pregnancies was found between the three groups. This study could not show a significant benefit of administration of tadalafil. However, a trend towards more pregnancies in the group treated with oral tadalafil is seen, more research in specific subgroups is needed.

Effect of Hysteroscopic Polypectomy Combined with Mirena Placement on Postoperative Adverse Reactions and Recurrence Rate of Endometrial Polyps: Based on a Large-Sample, Single-Center, Retrospective Cohort Study.

Objective To investigate the effect of hysteroscopy surgery combined with Mirena on postoperative adverse reactions and recurrence rate of endometrial polyps (EP). Methods A total of 312 patients who underwent hysteroscopic polypectomy of EP in our hospital from June 2017 to November 2020 were enrolled retrospectively. Among them, 42 patients did not take any treatment after the operation (control group), 156 patients were treated with levonorgestrel intrauterine birth control system (Mirena group), and 114 patients were treated with oral spironolone ethinylestradiol tablets (oral group). The clinical data of 312 patients were recorded and followed up regularly. All patients were followed up through an outpatient clinic or telephone to 12 months after the operation. The patients' age, disease course, number of pregnancies, clinical manifestations, endometrial thickness before the operation, duration of operation, amount of bleeding during the operation, and number and size of polyps were analyzed. The recurrence and postoperative side effects of EP in the three groups were followed up within 12 months after the operation. Results There was no significant difference in endometrial thickness among the three groups before treatment (P > 0.05). After 3 months, 6 months, and 12 months of treatment, the endometrial thickness of the three groups decreased, while the decrease in the Mirena group and the oral group was better compared to the control (P < 0.05). The decrease in the Mirena group was better than that in the oral group (P < 0.05). There was no significant difference in hemoglobin levels among the three groups before treatment (P > 0.05). After 3, 6, and 12 months of treatment, the hemoglobin levels of the three groups increased to varying degrees, while the levels of the Mirena group and oral group were better compared to the control (P < 0.05). Three months after the operation, the improvement of clinical symptoms was similar in the three groups, and there was no significant difference among the three groups (P > 0.05). At 6 and 12 months after the operation, the improvement of clinical symptoms in the oral group and Mirena group was better compared to the control group (P < 0.05), but there was no significant difference between the oral group and Mirena group (P > 0.05). After the operation, some patients had complications such as lower abdominal pain, breast distension pain, irregular vaginal bleeding, and abnormal liver function. There was no significant difference in the number of complications among the three groups (P > 0.05). During the follow-up to 12 months after the operation, the recurrence rate in the oral group and Mirena group was lower compared to the control (P < 0.05), and the recurrence rate in the Mirena group was lower than that in the oral group (P < 0.05). Conclusion Placing Mirena immediately after hysteroscopic polypectomy of EP can reduce the recurrence rate of endometrial polyps, increase the level of hemoglobin, and reduce the thickness of the endometrium, which can be employed and popularized according to the condition of patients in clinical work.

Effect of Tiaojingzhixue Fang on the expression of sex hormone and endometrial tissue mRNA in perimenopausal patients with abnormal uterine bleeding.

This study aimed to investigate the effect of Tiaojingzhixue decoction on the expression of sex hormone and endometrial mRNA in perimenopausal patients with abnormal uterine bleeding. For this purpose, 84 patients with perimenopausal abnormal uterine bleeding who were treated in our hospital from January 2018 to January 2019 were divided into study group and control group, the control group was treated with mifepristone for six months, the clinical efficacy, time of symptom relief and disappearance, endometrial thickness, menstrual volume, adverse events, expression of sex hormone (ER), Progesterone receptor (PR), Lutropin (LH), Follicle-stimulating hormone (FSH), Estradiol (e2) and Vascular endothelial growth factor in endometrial tissue were compared between the two groups. The results showed that the clinical efficacy of the study group (97.61%) was significantly higher than the control group (80.95%) (P<0.05). There was no significant difference in endometrial thickness between the two groups before treatment, but after treatment for 1 month, 3 months and 6 months, endometrial thickness was thinner in the study group (P<0.05). There was no significant difference in menstrual volume between the two groups before treatment (P <0.05), but it was lower in the study group (P <0.05). The incidence of adverse reactions in the study group was 11.90% lower than in the control group (26.19%). The expression levels of ER, PR, LH, FSH and E2 were almost the same before treatment and there was no significant difference between the two groups (P>0.05), but they were lower in the study group after treatment (P<0.05). Before treatment, there was no significant difference in the level of VEGF between the two groups (P>0.05); after treatment, the level of Vegf in the study group was lower than the control group (P<0.05). After treatment, the level of Vegf in both groups was significantly higher than before treatment (P<0.05). In general, Tiaojingzhixue decoction can decrease the level of sex hormone and increase the expression of VEGF in patients with perimenopausal abnormal uterine bleeding.

Endometrial and follicular development following stair-step and traditional protocols in women with polycystic ovary syndrome: An RCT

Background Various strategies have been proposed for polycystic ovary syndrome (PCOS) treatment.Objective To investigate and compare the number and size of ovarian follicles, endometrial thickness, and ovulation rate by traditional protocol (TP) and stair-step protocol (SSP).Materials and MethodsSixty infertile PCOS women were allocated into two groups (SSP = 30 and control TP = 30) between May and October 2019 in the Besat Hospital, Sanandaj, Iran. In the SSP group, the infertile women were treated with 50 mg/daily clomiphene citrate (CC) for five days, while the nonresponsive women were prescribed 100 mg daily CC for five days in the same cycle. The maximum dose (150 mg) was administered until ovulation occurred. In the control group, in non-ovulatory cases, the dose was increased in the next cycle. Ultrasound was used to detect ovulation.ResultsEndometrial thickness changes with various doses of CC were significantly different in the TP. The comparison of both protocols showed a significant difference in endometrial thickness only at 50 mg CC. The number of follicles in the left ovary was significantly different in both protocols at 150-mg CC. The size of ovarian follicles in the left ovary was significantly different between the two protocols at 100-mg CC. The ovulation rate was significantly different in the SSP at 100- and 150-mg doses of CC. Moreover, 86% of ovulation occurred at 100-mg CC in the SSP, while this rate was 73% in the TP.ConclusionThe most appropriate dose for ovulation in patients with PCOS is 100 mg CC.

Diagnostic value of different color ultrasound diagnostic method in endometrial lesions

BACKGROUNDEndometrial lesions include endometrial cancer and inferior fibroids. Among them, endometrial cancer as a malignant tumor seriously endangers the life and health of patients. Ultrasonography is an important means of diagnosing female reproductive system diseases, and it is of critical value for the early diagnosis of endometrial cancer. However, different ultrasound inspection programs have achieved different results. It is of great significance to choose a suitable inspection program.AIMTo explore the diagnostic efficacy of different ultrasonic examination methods in clinical endometrial lesions.METHODSThe 140 patients with endometrial lesions who were treated in our hospital from April 2018 to October 2019 were used as the research subjects. All patients underwent transvaginal color ultrasound and transabdominal color ultrasound. We compared the diagnostic coincidence and image display effects of the two different examination methods, and the endometrial thickness, blood flow, uterine effusion and resistance index of different diseases were observed by transvaginal color ultrasound.RESULTSThe diagnostic coincidence rate of all types of diseases of transvaginal color ultrasound was significantly higher than that of transabdominal color ultrasound (P = 0.001, 0.005, 0.001 and 0.001). In addition, the excellent and good rate of image display of transvaginal color ultrasound was higher than that of transabdominal color ultrasound (P = 0.001). There were significant differences in endometrial thickness in patients with different types of endometrial lesions through the transvaginal color examination (P = 0.001). The incidence rate of uterine effusion in patients with endometrial carcinoma was significantly higher than that in patients with other types of endometrial lesions (P = 0.001), and the rate of the blood flow was the highest (P = 0.001). The comparison of blood flow resistance index indicated that the blood flow resistance index in endometrial cancer patients was the lowest, which shows that the difference was statistically significant (P = 0.001).CONCLUSIONThe overall diagnostic efficacy of transvaginal color ultrasound in the clinical diagnosis of endometrial lesions is better than that of transabdominal color ultrasound, which held higher diagnostic coincidence rate and image display effect. There were significant differences in the thickness of the endometrium and the blood flow in different types of lesions.

The correlation between endometrial thickness and pregnancy outcomes in fresh ART cycles with different age groups: a retrospective study

BackgroundIn assisted reproductive technology (ART) cycles in addition to embryo quality, the receptivity of the endometrium plays the main role in clinical outcomes. Endometrial receptivity is necessary to implantation of an embryo, and ultrasound has been established as an appreciated, simple, and non-invasive technique in the evaluation of the endometrial preparation before embryo transfer in fresh in vitro fertilization (IVF) cycles. Debate on the predictive value measuring endometrial thickness before administering human chorionic gonadotropin (HCG) for ovulation triggering in ART is ongoing. In order to explore the impact of endometrial thickness on triggering day on ongoing pregnancy rate (OPR) in ART cycles, we retrospectively analyzed data from 1000 patients undergoing IVF/ICSI cycles.ResultsThe data showed pregnancy rate was increased in the endometrial thickness of 8 mm to 11 mm then decreased, and in endometrial thickness (Ent) > 14 mm, pregnancy rate was zero. There were significant differences in endometrial thickness and pregnancy outcomes between different age groups. The pregnancy rate was higher (32%) in 23–30 years old women, and the range of Ent in this group was 6–12 mm. Also, the data showed a positive correlation between Ent with AMH and estradiol levels and the number of COC and MII oocytes and a negative correlation between female age with Ent.ConclusionThe result showed that Ent on hCG administration day is associated with pregnancy outcomes in fresh IVF/ICSI cycles with different age groups, although some of the clinical parameters may have an effect on Ent. Large studies are needed to make a definitive conclusion.

Efficacy of intrauterine perfusion of peripheral blood mononuclear cells (PBMC) for infertile women before embryo transfer: meta-analysis

This meta-analysis was intended to evaluate the effects of intrauterine perfusion of peripheral blood mononuclear cells (PBMC) on the pregnancy outcomes including clinical pregnancy rates, embryo implantation rates, live birth rates and miscarriage rates of infertile women who were undergoing in vitro fertilisation (IVF) treatment. By searching Pubmed, Embase database, five articles meeting the inclusion criteria were included, and 1173 women were enrolled (intrauterine PBMC group: n = 514; NO-PBMC group: n = 659). For the entire IVF/ICSI population and one or two embryo transfer failure patients, there was no significant difference in endometrial thickness, embryo implantation rates, live birth rates, and miscarriage rates between the PBMC group and NO-PBMC group. Although the clinical pregnancy rates of the PBMC group were higher than that of the NO-PBMC group, the confidence interval was close to the line of unity. As for the patients with three or more implantation failures, the clinical pregnancy rates, embryo implantation rates and live birth rates were much higher in the PBMC group than that of the NO-PBMC group. In summary, current evidence suggests that intrauterine perfusion of PBMC can significantly improve pregnancy outcomes in patients who have three or more implantation failures. Impact statement What is already known on this subject? An increasing number of studies have shown that immune cells play an important role in embryo transfer. There is no reliable evidence to confirm the clinical efficacy of intrauterine perfusion of PBMC. What do the results of this study add? The current evidence suggests that intrauterine perfusion of PBMC can significantly improve pregnancy outcomes in patients who have three or more implantation failures. What are the implications of these findings for clinical practice and/or further research? To the best of our knowledge, this meta-analysis is the first to evaluate the effect of intrauterine perfusion of PBMC on pregnancy outcomes before embryo transfer. Our study indicated that intrauterine perfusion of PBMC significantly increased clinical pregnancy rates, embryo implantation rates, and live birth rates in patients who failed more than three implants.

Abstract P1-11-11: Cimicifuga racemosa extract prevents menopausal syndrome in LHRHa treatment of breast cancer: A prospective randomized research

Abstract BACKGROUND Menopausal syndrome (MPS) is common in pre/peri-menopausal breast cancer patient receiving luteinizing-hormone releasing hormone analogue (LHRHa). According to the results of TEXT &amp; SOFT study, it could affect patients' life quality seriously and even caused 8%˜23% treatment break. Cimicifuga racemosa (Remifemin) is previously proved effective for MPS in nature menopause patients. We aim to design a prospective randomized research for investigating the effect of Remifemin on MPS which caused by LHRHa in breast cancer (NCT03339882). METHODS The pre/peri-menopausal patients diagnosed as early breast cancer planning for LHRHa were identified and randomly divided into two groups after surgery and chemotherapy if necessary: the Remifemin group (Remifemin 20mg twice a day for 12 weeks) and the control group. The primary endpoint is Kupperman menopause index (KMI). The estradiol (E2), follicle-stimulating hormone (FSH), luteinizing hormone (LH) levels in blood were also evaluated. RESULTS From January 2017 to December 2017, totally 85 patients (42 in Remifemin group and 43 in control group) were enrolled in Zhejiang Cancer Hospital and there were no significant differences in baseline characteristics including age, BMI, tumor stage, ER, PR, HER2, KMI and hormone levels between two groups (Table 1). At the time of 4, 8, 12 weeks after treatment, the KMI of Remifenmin group were all significantly lower than control group (Table 2, P&amp;lt;0.01) while no significant difference in E2, FSH and LH levels between the two groups (Table 2, P&amp;gt;0.05).There was no significant difference in endometrial thickness, ovarian cyst and Uterine fibroids except cervical cyst (P=0.02). CONCLUSION The use of Remifemin is oncological safe and reliable in preventing MPS which caused by LHRHa in breast cancer. The clinical characteristics of two groups Remifemin groupControl groupP n=42n=43 N(%)N(%) Age(years) 37.74±6.6037.16±6.280.68BMI (body mass index) 21.90±2.8321.65±3.010.69T stage02(4.76)2 (4.65)0.16 113 (30.95)22 (51.16) 227 (64.29)19 (44.19) N stage021 (50.00)24 (55.82)0.63 110 (23.81)12 (27.91) 26 (14.29)5 (11.63) 35 (11.90)2 (4.65) ERPositive30 (71.43)35 (81.40)0.28 Negative12 (28.57)8 (18.60) PRPositive30 (71.43)32 (74.42)0.76 Negative12 (28.57)11 (25.58) HER2Positive8 (19.05)10 (23.26)0.64 Negative34 (80.95)33 (76.74) Category of LHRHaGoserelin32 (76.19)28 (65.12)0.26 Leuprorelin10 (23.81)15 (34.88) Category of endocrine drugNone10 (23.81)6 (13.95)0.20 SERM5 (11.90)11 (25.58) AI27 (64.29)26 (60.47) The endpoints of two groups Remifemin groupControl groupP n=42n=43 KMI*Base line2.45±1.452.30±1.360.62 4th week3.83±1.868.37±4.19&amp;lt;0.01 8th week4.21±1.8011.00±4.48&amp;lt;0.01 12th week4.67±2.1611.98±4.93&amp;lt;0.01E2Base line134.24±64.14143.49±84.190.57 4th week20.26±14.8125.24±13.310.11 8th week13.55±8.1415.65±8.020.23 12th week10.83±7.3512.53±6.350.26FSHBase line8.88±11.4010.17±9.910.58 4th week8.23±9.935.40±6.450.12 8th week4.83±8.496.53±11.500.44 12th week3.65±7.557.28±16.010.19LHBase line6.77±6.319.62±10.590.14 4th week9.08±4.877.93±4.830.28 8th week11.76±11.8210.18±12.210.55 12th week7.27±4.956.90±4.380.72*Wilcoxon test Citation Format: Yu X, Wang C, Liang C, Xuan H, Yang H. Cimicifuga racemosa extract prevents menopausal syndrome in LHRHa treatment of breast cancer: A prospective randomized research [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-11-11.

Effects of pelvic floor bioelectrical stimulation on frozen embryo transfer patients with thin endometrium

This study was to observe the effects of pelvic floor bioelectrical stimulation on pregnancy outcome and serum estradiol (E2) and progesterone (P) levels in frozen embryo transfer patients with thin endometrium. 120 cases frozen embryo transfer patients with thin endometrium in our hospital from March 2016 to April 2017 were selected. These patients received artificial cycle replacement plan before embryo transfer. According to whether pelvic floor bioelectrical stimulation therapy was accepted, 120 cases of thin endometrial frozen embryo transfer were divided into control group and observation group. 50 cases of the control group received artificial cycle to prepare for embryo transplantation, while 70 cases of observation group received bioelectrical stimulation as intervention treatment on the basis of artificial cycle. The intima thickness, subintimal hemodynamic parameters, embryo implantation rate, and clinical pregnancy rate were compared between the two groups before and after treatment. There was no significant difference in endometrial thickness between the two groups on the 10th day of menstruation ( P &gt; 0.05). The thickness of endometrium and the index of intima growth in the observation group were significantly higher than those in the control group ( P &lt; 0.05). The pulsatility index, resistance index, and systolic and diastolic blood flow velocity ratio of subintimal blood flow in the observation group were significantly higher than those in the control group ( P &lt; 0.05). Before treatment, there was no significant difference in serum E2 and P between the two groups ( P &gt; 0.05). After treatment, the improvement of serum E2 and P in the observation group was significantly better than that of the control group ( P &lt; 0.05). The embryo implantation rate (25.7%) in the observation group was significantly higher than that in the control group (17.0%) ( P &lt; 0.05). The clinical pregnancy rate (47.1%) in the observation group was significantly higher than that in the control group (30%) ( P &lt; 0.05). In conclusion, the intervention of pelvic floor bioelectrical stimulation can improve the blood perfusion of thin endometrium, improve the endometrial receptivity, increase the implantation rate of frozen embryo transfer in patients with thin endometrium, and improve the level of serum estradiol and progesterone.

Therapeutic Effects of VEGF Gene-Transfected BMSCs Transplantation on Thin Endometrium in the Rat Model.

Objective Bone mesenchymal stem cells (BMSCs) transplantation has a therapeutic effect on the thin endometrium in animal researches and clinical trials. The present study aims at assessing whether transplantation of VEGF-transfected BMSCs (VEGF-BMSCs) have a better therapeutic effect on endometrial regeneration and endometrial receptivity compared with BMSCs therapy alone. Methods Sprague-Dawley (SD) rats were used in the study. Thin endometrium model was established with 95% ethanol injection into uterine. VEGF-BMSCs or BMSCs was transplanted via tail vein IV injection. Endometrial thickness, morphology, and pinopodes were assessed by hematoxylin and eosin (HE) staining and scanning electron microscope (SEM). The proteins and mRNAs expressions of markers for endometrial cells and endometrial receptivity were measured after treatment. The fertility testing was done to assess the embryo implantation efficiency. Results VEGF-BMSCs transplantation significantly increased endometrial thickness compared with the BMSCs group and the control group. There was no significant difference in endometrial thickness between VEGF-BMSCs group and sham operation group. Importantly, in protein level, expressions of cytokeratin, vitamin, VEGF, LIF, and integrin ανβ 3 in VEGF-BMSC group were increased dramatically compared with those of the control group and BMSC group both 4 days and 8 days after stem cells transplantation. Accordingly, mRNA expression of LIF and integrin α ν β 3 was significantly upregulated compared with those of the control group and BMSC group both 4 and 8 days after treatment. The pinopodes were developed better in the VEGF-BMSCs group and the sham operation group compared with BMSCs group and the control group. The number of embryo implantation is largest in the sham operation group, followed by VEGF-BMSCs group, BMSCs group, and the control group. Conclusions Transplantation of VEGF gene-transfected BMSCs may be a better therapeutic treatment for thin endometrium than stem cell therapy alone.

Does low-dose aspirin improve pregnancy rate in women undergoing frozen-thawed embryo transfer cycle? A pilot double-blind, randomized placebo-controlled trial.

To evaluate the effect of adjuvant low-dose aspirin therapy on clinical pregnancy rate and uterine perfusion in women undergoing frozen-thawed embryo transfer (FET) cycles. This study was performed as a pilot randomized, double-blind placebo-controlled trial, from May 2012 to February 2015. Overall, 60 available eligible women who were candidates for FET were randomly assigned to two groups receiving either 100 mg oral aspirin (n =30) or placebo (n =30). The primary outcome measure was clinical pregnancy rate. Secondary outcome measures were pulsatility index (PI), resistance index (RI), implantation rate, live birth rate and miscarriage rate. There was no significant difference in endometrial thickness, PI and RI. However, the study group had higher rates of clinical pregnancy, implantation, live birth (P = 0.042, P = 0.031 and P = 0.007, respectively) and lower rate of miscarriage (P = 0.020) as compared to the control group. Twin birth rate was comparable between the two groups. Our pilot study demonstrated that administration of low-dose aspirin in FET cycles results in better pregnancy, implantation and live birth rates without changing the uterine hemodynamics or endometrial thickness. However, further randomized clinical studies in larger populations are needed to confirm these findings.

Use of Letrozole versus clomiphene-estradiol for treating infertile women with unexplained infertility not responding well to clomiphene alone, comparative study

Abstract Background Clomiphene Citrate (CC) considered as first line treatment option for superovulation in patient with unexplained infertility. However, there is discrepancy between ovulation and conception rates. Objectives Compare the effect of Clomiphene citrate plus Estradiol Valerate with Letrozole on endometrial thickness, pregnancy and abortion rate in women with unexplained infertility. Design This was a randomized double blind study. Setting Zagazig University hospitals and a private practice setting. Patients &methods The study included 172 women unexplained infertility with improper endometrial response to CC in spite of good follicular response. They were randomly divided into two groups: Group A received 100 mg CC from day 3 to day 7 of menstruation and 4 mg Estradiol Valerate on the 8th day of menstruation until 14th day, Group B treated by 5 mg Letrozole from day 3 to 7 of menstruation. Main Outcome Measure(s) Endometrial thickness, pregnancy and miscarriage rates. Result(s) There was a statistically significant difference in endometrial thickness between the two groups, (p value Conclusion(s) Letrozole has good effect on endometrial thickness more than Clomid or Clomid plus estradiol when used in women with unexplained infertility with statistically significant difference, but there was no significant difference regarding pregnancy and abortion rate with slight increase toward Letrozole.

The effect of pentoxifylline and tocopherol combination on endometrium thickness: A systematic review and meta-analysis

Endometrial thickness is a key factor involved in achieving desired outcomes in assisted reproductive technology (ART). Various therapeutic modalities have been proposed to patients with thin endometrium. This study aimed to summarize the available findings regarding the effect of Pentoxifylline (PTX) and Tocopherol combination on improving endometrial thickness. The review included interventional studies, including randomized controlled trials (RCTs) and quasi-experimental studies, assessing PTX and vitamin E (Tocopherol) combination in women with thin endometrium. Electronic searches using the MeSH terms were conducted in the following databases: Medline, Embase, Scopus, Web of Science, and The Cochrane Library. The effect was measured as weighted mean difference (MD) and 95% confidence intervals (CI) by the random-effects model. The initial search yielded 66 potentially relevant articles. After studying these publications, 4 were potentially eligible and retrieved in full text (three before–after studies and one RCT). A meta-analysis of three quasi-experimental studies showed a significant difference in endometrial thickness after treatment (MD: 1.96 mm; 95% CI: 0.94–2.98, p < .001) but there was no difference in the mean of endometrial thickness between case and control groups (10.8 vs. 10.48 mm, p = .467) in aforementioned RCT. Although the effect of intervention was seen in quasi experimental studies but this finding was not confirmed in the only retrieved RCT. Due to the methodological weakness of the retrieved studies as well as the lack of appropriate clinical trial studies, there is no certainty about the effectiveness of the PTX and Tocopherol combination. Future trials with desirable design and larger sample size that address the limitations in the current evidence are needed before definitive claims can be made about the effect of PTX and Tocopherol combination. Practical applications Endometrial thickness is affected by many factors including age, genetic, estradiol levels, and previous injuries to endometrium. Many drugs and nutritional supplements have been studied on endometrial thickness in which PTX and Tocopherol in combination have been shown to have restoring effects on endometrium. It seems that the properties of PTX and Tocopherol could be favorable for endometrium restoration.

Endometrial thickness as a predictor of the reproductive outcomes in fresh and frozen embryo transfer cycles: A retrospective cohort study of 1512 IVF cycles with morphologically good-quality blastocyst.

To evaluate the relationship between endometrial thickness during fresh in vitro fertilization (IVF) cycles and the clinical outcomes of subsequent frozen embryo transfer (FET) cycles.FET cycles using at least one morphological good-quality blastocyst conducted between 2012 and 2013 at a university-based reproductive center were reviewed retrospectively. Endometrial ultrasonographic characteristics were recorded both on the oocyte retrieval day and on the day of progesterone supplementation in FET cycles. Clinical pregnancy rate, spontaneous abortion rate, and live birth rate were analyzed.One thousand five hundred twelve FET cycles was included. The results showed that significant difference in endometrial thickness on day of oocyte retrieval (P = .03) was observed between the live birth group (n = 844) and no live birth group (n = 668), while no significant difference in FET endometrial thickness was found (P = .261) between the live birth group and no live birth group. For endometrial thickness on oocyte retrieval day, clinical pregnancy rate ranged from 50.0% among patients with an endometrial thickness of ≤6 mm to 84.2% among patients with an endometrial thickness of >16 mm, with live birth rate from 33.3% to 63.2%. Multiple logistic regression analysis of factors related to live birth indicated endometrial thickness on oocyte retrieval day was associated with improved live birth rate (OR was 1.069, 95% CI: 1.011–1.130, P = .019), while FET endometrial thickness did not contribute significantly to pregnancy outcomes following FET cycles. The ROC curves revealed the cut-off points of endometrial thickness on oocyte retrieval day was 8.75 mm for live birth.Endometrial thickness during fresh IVF cycles was a better predictor of endometrial receptivity in subsequent FET cycles than FET cycle endometrial thickness. For those females with thin endometrium in fresh cycles, additional estradiol stimulation might be helpful for adequate endometrial development.

Combined analysis of endometrial thickness and pattern in predicting clinical outcomes of frozen embryo transfer cycles with morphological good-quality blastocyst: A retrospective cohort study.

To evaluate the combined effect of endometrial thickness and pattern on clinical outcomes in females following in vitro fertilization/intracytoplasmic sperm injection and frozen-thawed embryo transfer (IVF/ICSI-FET).FET cycles using at least 1 morphological good-quality blastocyst conducted between 2012 and 2013 at a university-based reproductive center were reviewed retrospectively. Endometrial ultrasonographic characteristics were recorded on the day of progesterone supplementation in FET cycles. In the combined analysis, endometrial thickness groups (group 1: equal or < 8 mm; group 2: >8 mm) were subdivided into 2 endometrial patterns (pattern A: triple-line; pattern B: no-triple line). Clinical pregnancy rate, spontaneous abortion rate, and live birth rate in different groups were analyzed.A total of 1512 cycles were reviewed. The results showed that significant differences in endometrial thickness and pattern were observed between the pregnant group (n = 1009) and no pregnant group (n = 503) (P < .05), while no significant differences were found between the live birth group (n = 844) and no live birth group (n = 668). Combined analysis revealed those with endometrial thickness > 8 mm and triple-line endometrial pattern had significant higher clinical pregnancy rates, while spontaneous abortion rates and live birth rates showed no significant differences among these subgroups.This study suggested neither individual nor combined analysis of endometrial thickness and pattern had predicting effects on live birth following IVF treatments, and embryo quality might be the one that really has effects.

Uterine artery blood flow and microvessel density by vaginal color Doppler ultrasonography in embryo implantation failure.

The purpose of this study was to investigate the clinical application of uterine artery blood flow parameters by vaginal color Doppler ultrasonography in patients with repeated embryo implantation failure and to examine the correlation between uterine artery blood flow parameters and microvessel density (MVD). We monitored the outcomes of in vitro fertilization and embryo transfer in eighty patients. We divided the patients into two groups: Pregnancy (successful pregnancy, n=50) and repeated implantation failure (more than two failures of in vitro fertilization-embryo transfer, n=30). The patients were subjected to vaginal color Doppler ultrasonography to measure endometrial thickness, peak systolic velocity/end diastolic velocity (S/D), pulsatility index (PI), resistance index (RI), and other uterine artery blood flow parameters. We found no significant differences in endometrial thickness (human chorionic gonadotropin endometrial thickness) and uterine artery blood flow parameters (S/D, PI) between the two groups. The RI value of endometrial blood flow was significantly higher in the repeated implantation failure group than that in pregnancy group. The endometrium MVD in the repeated implantation failure group was significantly lower than that of the pregnancy group. Spearman correlation analysis showed that S/D value of uterine artery blood flow in repeated implantation failure group was not correlated with MVD or uterine artery blood flow PI, but was positively correlated with RI. Endometrium MVD in patients with repeated implantation failure was significantly lower than that in patients with successful pregnancy during the implantation window. We also found a significant difference in uterine artery blood flow RI between the two groups. The uterine artery blood flow RI in patients with repeated implantation failure was positively correlated with MVD, which has clinical significance in predicting the outcome of embryo transfer.

Letrozole 2.5 mg Shows Higher Endometrial Thickness Compared to 5 mg Letrozole in Ovulation Induction

Objective: To compare the effects of ovulation induction with 2.5 mg letrozole to 5 mg letrozole by the number of mature follicles, endometrial morphology and endometrium thickness during the late follicular phase in infertility patient who successfully became pregnant.&#x0D; &#x0D; Method: This was a cross sectional study. We collected the data of infertility patient who successfully became pregnant after receiving ovulation induction regiment of 2.5 mg and 5 mg letrozole.&#x0D; &#x0D; Result: There mean number of follicles with diameter ≥ 18 mm was higher in group receiving 5 mg letrozole (1.64 SD ± 0.91) compared to group receiving 2.5 mg letrozole (1.37 SD ± 0.56) but statistically, there was no significant difference (p = 0.134). Endometrial thickness, which was measured by transvaginal ultrasound on the twelfth&#x0D; day of menstrual cycle, showed a significant difference (p = 0.023) between the groups. The endometrium was thicker in patients receiving 2.5 mg letrozole (7.83 mm SD ± 0.87) compared to patients receiving 5 mg letrozole (7.6 mm SD ± 1.10). The most common endometrium&#x0D; morphology found was triple line endometrium, both in group receiving 2.5 mg letrozole (65%) and in group receiving 5 mg letrozole (50%).&#x0D; &#x0D; Conclusion: There was a significant difference in endometrial thickness between the pregnant patients who had received 5 mg of letrozole and 2.5 mg of letrozole for ovulation induction and the most common endometrium morphology and description was triple line&#x0D; endometrium in both research groups. But there was no significant difference between the number of ≥ 18 mm follicles on 2.5 mg doses and 5 mg doses of letrozole.&#x0D; [Indones J Obstet Gynecol 2012; 36-3: 130-4]&#x0D; &#x0D; Keywords: endometrium morphology, endometrium thickness, infertility, letrozole, ovarium follicles