Endometrial ultrasonography as a predictor of pregnancy in an in-vitro fertilization programme after ovarian stimulation and gonadotrophin-releasing hormone and gonadotrophins

A total of 150 patients were submitted to in-vitro fertilization (IVF) and endometrial pattern and thickness were assessed on the day of administration of human chorionic gonadotrophin (HCG). Ovarian stimulation was performed with gonadotrophins [human menopausal (HMG) or follicle stimulating hormone (FSH)] after down-regulation with leuprolide acetate. The endometrium was evaluated by vaginal ultrasound and classified into two groups: pattern I (a 'triple line' multilayer) and pattern II (fully homogeneous and hyperechogenic in relation to myometrial tissue). Pattern I was detected in 129 cycles (86%) and pattern II in 21 cycles (14%). The clinical pregnancy rates per cycle were similar (P = 0.79) for pattern I (29.4%) and pattern II (33.3%). There was no significant difference (P = 0.40) in the number of miscarriages between patients with pattern I and those with pattern II. Endometrial thicknesses were similar (10.3 +/- 2.0 mm and 11.2 +/- 3.1 mm) (P = 0.25). The thicknesses were similar (P = 0.14) for pregnant (10.8 +/- 2.1 nun) and non-pregnant (10.2 +/- 2.2 mm) women, but no pregnancies occurred when thickness was <7.0 mm. However, there was a significant difference (P = 0.04) between pregnant (10.8 +/- 1.9 mm) and non-pregnant (10.0 +/- 1.9 mm) women who showed pattern I. The conclusions from these data are that endometrial ultrasound in terms of pattern and thickness is of no prognostic value in IVF cycles on the day of administration of HCG. However, a minimum thickness has to be achieved for pregnancy to occur (7.0 mm). The presence of pattern I appears more likely to favour pregnancy.