Rates of exponential increase of serum estradiol concentrations in normal and human menopausal gonadotropin-induced cycles

Endometrial thickness and IVF cycle outcomes: a meta-analysis

RESEARCH QUESTION

In this meta-analysis, the association between endometrial thickness (EMT) and cycle outcomes after IVF is explored. Associations between EMT and cycle outcomes according to study and individual characteristics were also assessed.

DESIGN

Studies evaluating associations between EMT and pregnancy, implantation, miscarriage, live birth or ongoing pregnancy and ectopic pregnancy rates in individuals after IVF were identified on PubMed, Embase and the Cochrane Library (from their inception up to December 2018). Pooled odds ratios with 95% confidence intervals, calculated using the random-effects model, were used.

RESULTS

Nine prospective and 21 retrospective studies, including a total of 88,056 cycles, were retrieved. The summary odds ratios indicated that women with lower EMT were associated with lower pregnancy rates than those with higher EMT (n = 30, OR 0.61; 95% CI 0.52 to 0.70; P < 0.001). Moreover, the implantation rate in women with lower EMT was significantly reduced (n = 9, OR 0.49; 95% CI 0.32 to 0.74; P = 0.001). Furthermore, no significant association was found between EMT and the miscarriage rate (n = 12). In addition, women with lower EMT were associated with reduced live birth or ongoing pregnancy rate (11 studies, OR 0.60; 95% CI 0.48 to 0.73; P < 0.001). Finally, the incidence of ectopic pregnancy rate between lower and higher EMT showed no statistically significant association (n = 3).

CONCLUSIONS

Lower EMT was associated with lower pregnancy, implantation and live birth or ongoing pregnancy rates.

Prospective evaluation of the ultrasound appearance of the endometrium in a cohort of 1,186 infertile women

OBJECTIVE

To investigate the effect of differences in endometrial thickness and pattern as visualized with present-day high-resolution transvaginal ultrasound equipment on the outcome of assisted reproductive treatment.

DESIGN

Prospective cohort study.

SETTING

Two large infertility units in university hospitals.

PATIENT(S)

The endometrial characteristics of 981 patients during 1,600 assisted reproductive treatment cycles were compared with those of 205 untreated women. In addition, abnormal echogenic patterns of the endometrium were characterized histologically in 44 patients.

INTERVENTION(S)

None.

MAIN OUTCOME MEASURE(S)

Pregnancy rates.

RESULT(S)

The endometrium was significantly thinner in untreated women and women treated with IUI than in women treated with IVF or intracytoplasmic sperm injection. The exponential proliferation of the endometrium was similar in conception and nonconception cycles. The odds for a successful pregnancy were significantly lower in the presence of a thin endometrium in women treated with IUI but not in women treated with the long stimulation protocol for IVF or intracytoplasmic sperm injection. Singleton pregnancies were more common than multiple pregnancies in patients with thin endometria.

CONCLUSION(S)

The pregnancy rates of assisted reproductive procedures are influenced only marginally by the degree of endometrial proliferation, and treatment should not be canceled because of inadequate endometrial thickness.

Evaluation of the exponential rise of serum estradiol concentrations in human menopausal gonadotropin-induced cycles

To determine whether the rate of the exponential rise of estradiol (RER-E2) may be useful in monitoring gonadotropin-induced cycles and have prognostic value with respect to pregnancy, the RER-E2 was evaluated in 70 ovulatory cycles of 25 women. Semilogarithmic plots of E2 concentrations (picograms per milliliter) versus time (days) were linear, with slopes (RER-E2) ranging from 0.18 to 0.74. The mean RER-E2 in the 14 cycles of conception (0.49 +/- 0.03; +/- standard error) was not significantly different from the mean (0.47 +/- 0.02) in 56 cycles in which pregnancy did not occur. The mean of the RER-E2 of three twin pregnancies (P less than 0.02) and of three pregnancy losses (P less than 0.01) were significantly higher than the mean of nine singleton pregnancies. There was a lower pregnancy rate at the lower range of RER-E2 and a higher frequency of twin pregnancies and pregnancy losses at the upper range, but these trends were not statistically significant. By a graphic method, subsequent E2 values were predicted in 25 of 28 cycles within the 95% confidence limits and a clinically acceptable range of actual E2 values. The semilogarithmic plots appear to be useful adjuncts in the monitoring of gonadotropin-induced cycles. Although the data suggest that the RER-E2 may have prognostic value, further study is needed to confirm these observations.