Risk factors for the development of a thin endometrium and the impact on the outcomes of assisted reproductive technology programs
DOI:
https://doi.org/10.37800/RM.1.2023.35-41Keywords:
thin endometrium, infertility, in vitro fertilization (IVF)Abstract
Relevance: The effect of endometrial thickness on the outcome of assisted reproductive technology (ART) programs is still under discussion. Some studies have shown that this parameter is important for predicting the outcome of ART cycles, while other studies have not shown a positive effect. In the third category of studies, endometrial thickness was associated with the outcome of in vitro fertilization, but only in combination with other parameters.
The study aimed to explore the risk factors for developing thin endometrium and to assess the effect of endometrial thickness on the outcome of ART programs.
Materials and methods: 200 patients undergoing ART were selected to participate in the study. The patients were divided into three groups by endometrial thickness (Group 1 – 7.0-7.9 mm, Group 2 – 8.0-8.9 mm, and Group 3 – 9.0-10.0 mm) to assess the effect of endometrial thickness on the outcome of ART programs. All women underwent transvaginal ultrasound examination and were prescribed standard therapy with estradiol valerate 2 mg 1 tablet t.i.d. The endometrial thickness on Day 13 of the menstrual cycle was considered final. From the same day on, the patients were prescribed vaginal progesterone 200 mg t.i.d. Embryo transfer was performed when the endometrium reached 7 mm using a special catheter on the 19th day of the menstrual cycle.
Results: Older patients were in the 1st group with an endometrium of 7.0-7.9 mm, and the youngest patients were in the 3rd group (9.0-10.0 mm). In Group 1 of patients, the endocrine factor of infertility prevailed (33.3%); in Group 2 – the tubal factor (29.2%); and in Group 3 – the male factor (36.1%). More than half of the participants with thin endometrium had risk factors such as curettage of the uterine cavity (37.5%) or chronic endometritis (22.9%). In comparison, 87.5% of Group 3 patients had no risk factors. The percentage of pregnancy also increased markedly with increasing endometrial thickness. The lowest percentage of clinical pregnancy was in the 1st group of patients (27.0%) and the highest in the 3rd group (51.4%). The threshold value at which pregnancy will not occur is the endometrial thickness of less than 7.5 mm. And the thickness at which the chances of a positive outcome exceed a negative result is 8.5 mm.
Conclusion: In our study, curettage of the uterine cavity and chronic endometritis deteriorate endometrial thickness. We also determined that the chances of a successful outcome of ART programs increase with increased endometrial thickness, and the minimum recommended endometrial thickness for transfer is 7.5 mm.
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