Relation of endometrial thickness and pregnancy rates in intrauterine insemination following ovulation induction
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20151609Keywords:
Ovulation induction, Endometrial thickness, Clinical pregnancy, Intrauterine inseminationAbstract
Background: Controlled ovarian hyper stimulation (COH) using different agents with intrauterine insemination (IUI) are known treatment for infertility. Endometrial thickness (ET) is one of the predicting factors for clinical pregnancy along with other parameters. Many studies have been done in the past to find factors affecting the growth and maturity of the endometrium in women in IUI, but indigenous Indian studies regarding its relation with pregnancy were either limited or the results were unclear.
Methods: A Prospective observational study was undertaken for assessing effects of clomiphene citrate (CC) and human menopausal gonadotropin (hMG) stimulated cycles on the ET and clinical pregnancy in single IUI cycle. Infertility cases were studied in two groups; Group A [ovulation induction (OI) with CC and IUI; n=101] and Group B (OI with hMG and IUI; n=103) after randomization using random number table as per standard protocol.
Results: Comparable data obtained in mean age, duration of infertility, female and male factors in both groups. Mean ET on day of IUI in Group A and B was 8.35+2.08mm and 10.87+2.54mm respectively (p value <0.001). Range of ET in clinical pregnancies in Group A (n= 15) were 8.0- 12.9mm and 9.0- 12.9mm in Group B (n= 26). Ongoing pregnancies beyond 1st trimester were higher in Group B (n= 25) than Group A (n= 14).
Conclusions: Mean ET and clinical pregnancy rate both were higher in hMG group compared to CC. This study identified an ‘optimum endometrial thickness’ (9.0-12.9mm) for achieving clinical pregnancy in hMG group.
References
Burney RO, Schust DJ, Yao MWM. Infertility. In: Berek JS, 14 eds. Berek & Novak’s Gynecology. New Delhi: Lippincott Williams & Wilkins. 2007: 1185-1276.
Cunningham FG, Leveno KJ, Bloom SL, Hauth JC, Rouse DJ, Spong CY. From Williams Obstetrics, USA. McGraw-Hill Companies; 2010. Figure 3-2, Photomicrographs illustrating endometrial changes during menstrual cycle; p-38.
Dodge ST, Strickler RC, Keller DW. Ovulation induction with low doses of clomiphene citrate.ObstetGynecol. 1986;67:63S.
Randall JM, Templeton A. Transvaginal sonographic assessment of follicular and endometrial growth in spontaneous and clomiphene citrate cycles. FertilSteril. 1991;56(2):208-12.
Diamond MP, Wentz AC. Ovulation induction with human menopausal gonadotropins. Obstet Gynecol Surv. 1986;41(8):480-90.
Verhulst SM, Cohlen BJ, Hughes E, TeVelde E, Heineman MJ. Intrauterine insemination for unexplained subfertility. Cochrane Database Syst Rev .2006;18:CD001838.
Nuojua-Huttunen S, C Thomas C, Bloigu R, Tuomivaara L, Martikainen H. Intrauterine insemination treatment in subfertility: an analysis of limiting factors affecting outcome. Hum Reprod. 1999;14:698-703.
Tomlinson MJ, Amissah-Arthur JB, Thompson KA, Kasraie JL, Bentick B. Prognostic indicators for intrauterine insemination (IUI): statistical model of IUI success. Hum Reprod .1996;11:1892-6.
Check JH, Davies E, Adelson H. A randomized prospective study comparing pregnancy rates following clomiphene citrate and human menopausal gonadotrophin therapy. Hum Reprod. 1992;7:801-5.
Ecochard R, Mathieu C, Royere D, Blache G, Rabilloud M, Czyba JC. A randomized prospective study comparing pregnancy rates after clomiphene citrate and human menopausal gonadotropin before intrauterine insemination. FertilSteril. 2000;73:90-3.
Coulam CB, Soenksen DM, Britten S. Ultrasonographic predictors of implantation after assisted reproduction. FertilSteril. 1994;62:1004–10.
Schild RL, Eschweiler S, Van Der Ven H, Fimmers R, Hansmann M. Three dimensional endometrial volume calculation and pregnancy rate in an in vitro fertilization programme. Hum Reprod.1999; 14:1255–8.
Kupesic S. Three-dimensional ultrasonographic uterine vascularisation and embryo implantation. J Gynecol Obstet Biol Reprod. 2004;33:S18–20.
Dickey RP, Olar TT, Taylor SN, Curole DN, Matulich EM. Relationship of endometrial thickness and pattern to fecundity in ovulation induction cycles: effect of clomiphene citrate alone and with human menopausal gonadotropin. Fertil Steril. 1993;59:756-60.