Relationships between pregnancy rates following in vitro fertilization or intracytoplasmic sperm injection and endometrial thickness and pattern



      To investigate the role of endometrial thickness and pattern on the day of human chorionic gonadotropin (hCG) administration on in vitro fertilization (IVF)/intracytoplasmic injection (ICSI) outcome.

      Study design:

      A total of 150 infertile women undergoing embryo transfer after IVF/ICSI cycles were studied in a prospective survey. Sonographic features of the endometrium (thickness and pattern) on the day of hCG administration, hormonal profile (progesterone, estradiol, FSH, LH) and various other variables (maternal age, causes and duration of infertility, duration of treatment, number of human menopausal gonadotropin (hMG) ampoules administered, and number of oocytes retrieved) were evaluated. These variables in pregnant and nonpregnant patients were compared.


      There was no difference between pregnant and nonpregnant patients in mean endometrium thickness (10.1 ± 1 versus 10.2 ± 2, p = 0.79). Pregnancies occurred only in patients with an endometrial thickness of 9–12 mm (p = 0.036). Duration of treatment, number of hMG ampoules administered, number of oocytes retrieved, estradiol concentration, and estradiol/progesterone ratio on the day of hCG differed significantly between pregnant and nonpregnant patients. There was no correlation between endometrial pattern and pregnancy rate. The receiver-operating characteristic (ROC) curve and multiple logistic regression showed no significant effect of endometrial thickness in the outcome of IVF/ICSI.


      The sonographic features of the endometrium (thickness and pattern) on the day of hCG administration did not differ between pregnant and nonpregnant patients. The pregnancy rate declined beyond two limits of endometrial thickness.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


        • Yaman C.
        • Ebner T.
        • Sommergruber M.
        • Polz W.
        • Tews G.
        Role of three-dimensional ultrasonographic measurement of endometrium volume as a predictor of pregnancy outcome in an IVF-ET program: a preliminary study.
        Fertil Steril. 2000; 74: 797-801
      1. SART and ASRAM. Assisted reproductive technology in the United States and Canada: 1994 results generated from the American Society for Reproductive Medicine/Society for Assisted Reproductive Technology Registry. Fertil Steril 1996; 66: 697–705.

        • Gonen Y.
        • Robert F.C.
        • Jacobson W.
        • Blankier J.
        Endometrial thickness and growth during ovarian stimulation: a possible predictor of implantation in in vitro fertilization.
        Fertil Steril. 1989; 52: 446-450
        • Check J.H.
        • Nowroozi K.
        • Choe J.
        • Lurie D.
        • Dietterich C.
        The effect of endometrial thickness and echo pattern on in vitro fertilization outcome in donor oocyte–embryo transfer cycle.
        Fertil Steril. 1993; 59: 72-75
        • Dickey R.P.
        • Olar T.T.
        • Curole D.N.
        • Taylor S.N.
        • Rye P.H.
        Endometrial pattern and thickness associated with pregnancy outcome after assisted reproduction technologies.
        Hum Reprod. 1992; 7: 418-421
        • Check J.H.
        • Lurie D.
        • Dietterich C.
        • Callan C.
        • Baker A.
        Adverse effect of homogenous hyperechogenic endometrial sonographic pattern, despite adequate endometrial thickness on pregnancy rates following in vitro fertilization.
        Hum Reprod. 1993; 8: 1293-1296
        • Remohi J.
        • Ardiles G.
        • Garcia-Velasco J.A.
        • Gaitan P.
        • Simon C.
        • Pellicer A.
        Endometrial thickness and serum oestradiol concentrations as predictors of outcome in oocyte donation.
        Hum Reprod. 1997; 12: 2271-2276
        • Kovacs P.
        • Matyas S.
        • Boda K.
        • Kaali S.G.
        The effect of endometrial thickness on IVF/ICSI outcome.
        Hum Reprod. 2003; 18: 2337-2341
        • Weissman A.
        • Gotlieb L.
        • Casper R.F.
        The detrimental effect of increased endometrial thickness on implantation and pregnancy rates and outcome in an in vitro fertilization program.
        Fertil Steril. 1999; 71: 147-149
        • Noyes N.
        • Liu H.C.
        • Sultan K.
        • Schattman G.
        • Rosenwaks Z.
        Endometrial thickness appears to be a significant factor in embryo implantation in in vitro fertilization.
        Hum Reprod. 1995; 10: 919-922
        • De Geyter C.
        • Schmitter M.
        • De Geyter M.
        • Nieschlag E.
        • Holzgreve W.
        • Schneider H.P.
        Prospective evaluation of the ultrasound appearance of the endometrium in a cohort of 1,186 infertile women.
        Fertil Steril. 2000; 73: 106-113
        • Puerto B.
        • Creus M.
        • Carmona F.
        • Civico S.
        • Vanrell J.A.
        • Balasch J.
        Ultrasonography as a predictor of embryo implantation after in vitro fertilization: a controlled study.
        Fertil Steril. 2003; 79: 1015-1022
        • Yuval Y.
        • Lipitz S.
        • Dor J.
        • Achiron R.
        The relationships between endometrial thickness, and blood flow and pregnancy rates in in vitro fertilization.
        Hum Reprod. 1999; 14: 1067-1071
        • Oliveria J.B.A.
        • Baruffi R.L.P.
        • Mauri A.L.
        Endometrial ultrasonography as a predictor of pregnancy in an in vitro fertilization program after ovarian stimulation and gonadotropin releasing hormone and gonadotropins.
        Hum Reprod. 1997; 12: 2515-2518
        • Schild R.L.
        • Indefrei D.
        • 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: 1255-1258
        • Coulam C.B.
        • Bustillo M.
        • Soenksen D.M.
        • Britten S.
        Ultrasonographic predictors of implantation after assisted reproduction.
        Fertil Steril. 1994; 62: 1004-1010
        • Vera J.A.
        • Arguello B.
        • Crisosto C.A.
        Predictive value of endometrial pattern and thickness in the result of in vitro fertilization and embryo transfer.
        Rev Chil Obstet Ginecol. 1995; 60: 195-198
        • Friedler S.
        • Schenker J.G.
        • Herman A.
        • Lewin A.
        The role of ultrasonography in the evaluation of endometrial receptivity following assisted reproductive treatment: a critical review.
        Hum Reprod Update. 1996; 2: 323-325
        • Sharara F.I.
        • Lim J.
        • McClamrock H.D.
        Endometrial pattern on the day of oocyte retrieval is more predictive of implantation success than the pattern or thickness on the day of hCG administration.
        J Assist Reprod Genet. 1999; 16: 523-528
        • Fanchin R.
        • Righini C.
        • Ayoubi J.M.
        • Olivennes F.
        • de Ziegler D.
        • Frydman R.
        New look at endometrial echogenicity: objective computer-assisted measurements predict endometrial receptivity in in vitro fertilization-embryo transfer.
        Fertil Steril. 2000; 74: 274-281
        • Bustillo M.
        • Krysa L.W.
        • Coulam C.B.
        Uterine receptivity in an oocyte donation programme.
        Hum Reprod. 1995; 10: 442-445
        • Serafini P.
        • Batzofin J.
        • Nelson J.
        • Olive D.
        Sonographic uterine predictors of pregnancy in women undergoing ovulation induction for assisted reproductive treatments.
        Fertil Steril. 1994; 62: 815-822
        • Hock D.L.
        • Bohrer M.K.
        • Ananth C.V.
        • Kemmann E.
        Sonographic assessment of endometrial pattern and thickness in patients treated with clomiphene citrate, human menopausal gonadotropins, and intrauterine insemination.
        Fertil Steril. 1997; 68: 242-245
      2. Basir GS, O WS, So WW, Ng EH, Ho PC. Evaluation of cycle-to-cycle variation of endometrial responsiveness using transvaginal sonography in women undergoing assisted reproduction. Ultrasound Obstet Gynecol 2002; 19: 484–489.

        • Bassil S.
        Changes in endometrial thickness, width, length and pattern in predicting pregnancy outcome.
        Ultrasound Obstet Gynecol. 2001; 18: 258-263
        • Kupesic S.
        • Bekavac I.
        • Bjelos D.
        • Kurjak A.
        Assessment of endometrial receptivity by transvaginal color Doppler and three-dimensional power Doppler ultrasonography in patients undergoing in vitro fertilization procedures.
        J Ultrasound Med. 2001; 20: 125-134
        • Dietterich C.
        • Check J.H.
        • Choe J.K.
        • Nazari A.
        • Lurie D.
        Increased endometrial thickness on the day of human chorionic gonadotropin injection does not adversely affect pregnancy or implantation rates following in vitro fertilization-embryo transfer.
        Fertil Steril. 2002; 77: 781-786
        • Rinaldi L.
        • Lisi F.
        • Floccari A.
        • Lisi R.
        • Pepe G.
        • Fishel S.
        Endometrial thickness as a predictor of pregnancy after in vitro fertilization but not after intracytoplasmic sperm injection.
        Hum Reprod. 1996; 11: 1538-1541
        • Gonen Y.
        • Casper R.F.
        Prediction of implantation by the sonographic appearance of the endometrium during controlled ovarian stimulation for in vitro fertilization (IVF).
        J In Vitro Fertil Embryo Transf. 1990; 7: 146-152
        • Schild R.L.
        • Knobloch C.
        • Dorn C.
        • Fimmers R.
        • van der Ven H.
        • Hansmann M.
        Endometrial receptivity in an in vitro fertilization program as assessed by spiral artery blood flow, endometrial thickness, endometrial volume, and uterine artery blood flow.
        Fertil Steril. 2001; 75: 361-366
        • Ueno J.
        • Oehninger S.
        • Brzyski R.G.
        • Acosta A.A.
        • Philput C.B.
        • Muasher S.J.
        Ultrasonographic appearance of the endometrium in natural and stimulated in vitro fertilization cycles and its correlation with outcome.
        Hum Reprod. 1991; 6: 901-904
        • Bergh C.
        • Hillensjo T.
        • Nilsson L.
        Sonographic evaluation of the endometrium in in vitro fertilization IVF cycles. A way to predict pregnancy?.
        Acta Obstet Gynecol Scand. 1992; 71: 624-628