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Li S, Yin T, Li W, Yang J, Xu W, Zhou D. Association between follicular fluid levels of HMGB1 protein and outcomes in patients undergoing in vitro fertilization/intracytoplasmic sperm injection cycles. Exp Ther Med 2015; 9:1611-1616. [PMID: 26136867 DOI: 10.3892/etm.2015.2369] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 02/10/2015] [Indexed: 12/31/2022] Open
Abstract
The aim of the present study was to evaluate the association between follicular fluid (FF) levels of high-mobility group box 1 (HMGB1) protein and the reproductive outcome in patients undergoing in vitro fertilization (IVF) with intracytoplasmic sperm injection (ICSI). FF samples were collected from the ovarian follicles (≥14 mm) of 143 infertile patients that had undergone IVF/ICSI, and the HMGB1 expression levels were determined using ELISA. Spearman's correlation and receiver operating characteristic (ROC) curve analysis were applied to analyze the results. Significantly increased levels of HMGB1 protein (7.38±2.02 vs. 6.14±2.52 ng/ml; P<0.01), endometrial thickness on the day of human chorionic gonadotropin (hCG) administration (10.3±1.3 vs. 9.7±1.7 mm; P<0.01) and retrieved oocyte counts (11.68±6.51 vs. 11.00±6.34; P<0.01) were observed in the pregnant group when compared with the non-pregnant group. Conversely, the level of luteinizing hormone on the day of hCG administration was significantly reduced in the pregnant group compared with the non-pregnant group (0.92±1.78 vs. 1.78±2.03 pmol/l, P<0.01). The ROC curve indicated a significant association between the FF level of HMGB1 protein and the pregnancy rate, with an area under the ROC curve of 0.673 (0.581-0.765; P<0.01). In addition, the HMGB1 protein level was shown to have a significant positive correlation with the endometrial thickness (r=0.170; P<0.05). Therefore, the present study indicated that the FF levels of HMGB1 protein are increased in pregnant patients and are positively correlated with endometrial thickness. Thus, FF levels of HMGB1 may be a useful factor for predicting the outcome of IVF/ICSI treatments.
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Affiliation(s)
- Saijiao Li
- Reproductive Medicine Center, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
| | - Tailang Yin
- Reproductive Medicine Center, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
| | - Wei Li
- Reproductive Medicine Center, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
| | - Jing Yang
- Reproductive Medicine Center, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
| | - Wangming Xu
- Reproductive Medicine Center, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
| | - Danni Zhou
- Reproductive Medicine Center, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
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Al Mohammady M, Abdel Fattah G, Mahmoud M. The impact of combined endometrial thickness and pattern on the success of intracytoplasmic sperm injection (ICSI) cycles. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2013. [DOI: 10.1016/j.mefs.2013.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Heger A, Sator M, Pietrowski D. Endometrial Receptivity and its Predictive Value for IVF/ICSI-Outcome. Geburtshilfe Frauenheilkd 2012; 72:710-715. [PMID: 25258462 DOI: 10.1055/s-0032-1315059] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Revised: 06/12/2012] [Accepted: 06/26/2012] [Indexed: 10/28/2022] Open
Abstract
Endometrial receptivity plays a crucial role in the establishment of a healthy pregnancy in cycles of assisted reproduction. The endometrium as a key factor during reproduction can be assessed in multiple ways, most commonly through transvaginal grey-scale or 3-D ultrasound. It has been shown that controlled ovarian hyperstimulation has a great impact on the uterine lining, which leads to different study results for the predictive value of endometrial factors measured on different cycle days. There is no clear consensus on whether endometrial factors are appropriate to predict treatment outcome and if so, which one is suited best. The aim of this review is to summarize recent findings of studies about the influence of endometrial thickness, volume and pattern on IVF- and ICSI-treatment outcome and provide an overview of future developments in the field.
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Affiliation(s)
- A Heger
- Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - M Sator
- Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria ; Fertility Center Doebling, Ambulatorium Doebling, Vienna, Austria
| | - D Pietrowski
- Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria ; Fertility Center Doebling, Ambulatorium Doebling, Vienna, Austria
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Momeni M, Rahbar MH, Kovanci E. A meta-analysis of the relationship between endometrial thickness and outcome of in vitro fertilization cycles. J Hum Reprod Sci 2012; 4:130-7. [PMID: 22346080 PMCID: PMC3276947 DOI: 10.4103/0974-1208.92287] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2011] [Revised: 06/04/2011] [Accepted: 09/21/2011] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE: The objective was to evaluate the relationship between endometrial thickness on the day of human chorionic gonadotropin administration and pregnancy outcome in in vitro fertilization cycles. DESIGN: This was a systematic review and meta-analysis. MATERIALS AND METHODS: We identified 484 articles using Cochrane library, PubMed, Web of Science, and Embase searches with various key words including endometrial thickness, pregnancy, assisted reproductive technology, endometrial pattern, and in vitro fertilization. A total of 14 studies with data on endometrial thickness and outcome were selected, representing 4922 cycles (2204 pregnant and 2718 nonpregnant). The meta-analysis with a random effects model was performed using comprehensive meta-analysis software. We calculated the standardized mean difference, odds ratio (OR), and 95% confidence intervals (CIs). RESULTS: There was a significant difference in the mean endometrial thickness between pregnant and nonpregnant groups (P<0.001), with a standardized mean difference of 0.4 mm (95% CI 0.22–0.58). The OR for pregnancy was 1.40 (95% CI 1.24–1.58). CONCLUSIONS: The mean endometrial thickness was significantly higher in pregnant women compared to nonpregnant. The mean difference between two groups was <1 mm which may not be clinically meaningful. Although there may be a relationship between endometrial thickness and pregnancy, implantation potential is probably more complex than a single ultrasound measurement can determine.
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Affiliation(s)
- Mazdak Momeni
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA
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Dmitrovic R, Vlaisavljevic V, Ivankovic D. Endometrial growth in early pregnancy after IVF/ET. J Assist Reprod Genet 2008; 25:453-9. [PMID: 18853245 DOI: 10.1007/s10815-008-9260-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2008] [Accepted: 09/26/2008] [Indexed: 10/21/2022] Open
Abstract
PURPOSE To detect the endometrial volume change in conception cycles. Additionally we measured endometrium in three planes, to see if the hypothesized endometrial volume differences will be detectable by this surrogate technique. METHODS Following the embryo transfer, a three-dimensional ultrasound exam was performed on average days 22 and 28 of the cycle. RESULTS Seventy-eight subjects signed the informed consent form, and 63 completed the study. A significant difference was observed between Visit 1 and Visit 2, for endometrial volume, thickness, length and width in the pregnant group, and for endometrial volume, thickness and width in the non-pregnant group. CONCLUSIONS In this study we have shown that in normal intrauterine pregnancy after IVF/ET, prominent endometrial volume growth can be detected by a three-dimensional ultrasound over the course of several days. Moreover, in patients who did not conceive in a particular cycle, a decrease in endometrial volume can be seen.
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Affiliation(s)
- Romana Dmitrovic
- Nova Gradiska General Hospital, 35400 Nova Gradiska, Croatia, Croatia.
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Detti L, Yelian FD, Kruger ML, Diamond MP, Rode A, Mitwally MFM, Puscheck EE. Endometrial thickness is related to miscarriage rate, but not to the estradiol concentration, in cycles down-regulated with gonadotropin-releasing hormone antagonist. Fertil Steril 2008; 89:998-1001. [PMID: 17678904 DOI: 10.1016/j.fertnstert.2007.04.027] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2006] [Revised: 04/05/2007] [Accepted: 04/05/2007] [Indexed: 10/23/2022]
Abstract
In this retrospective cohort study of 102 ovarian stimulation cycles for IVF/intracytoplasmic sperm injection using GnRH antagonist and gonadotropins, we sought to assess the effect of high E(2) levels on endometrial stripe thickness and its association with pregnancy outcomes and serum E(2) levels. We found no significant correlation between serum E(2) levels (both peak and area under the curve E(2) concentration) and the endometrial thickness. However, there was a statistically significant inverse relationship with early pregnancy loss (31%) if the endometrial thickness was <9.8 mm (sensitivity 71%; specificity 76%).
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Affiliation(s)
- Laura Detti
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Wayne State University School of Medicine, Detroit, Michigan 48201, USA.
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Hendriks DJ, Mol BWJ, Bancsi LFJMM, te Velde ER, Broekmans FJM. The clomiphene citrate challenge test for the prediction of poor ovarian response and nonpregnancy in patients undergoing in vitro fertilization: a systematic review. Fertil Steril 2006; 86:807-18. [PMID: 16962116 DOI: 10.1016/j.fertnstert.2006.03.033] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2005] [Revised: 03/03/2006] [Accepted: 03/03/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To systematically review the value of the clomiphene citrate challenge test (CCCT) in the prediction of poor ovarian response and pregnancy in IVF. DESIGN Systematic review. SETTING All studies that evaluated the CCCT in the prediction of poor ovarian response or pregnancy after IVF. PATIENT(S) Infertility population undergoing an IVF treatment. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Poor ovarian response, nonpregnancy. RESULT(S) From the literature we identified and analyzed 12 studies on the CCCT according to preset criteria. In predicting poor response, the sensitivity and specificity of the CCCT varied from 35% to 93% and 47% to 98%, respectively. In predicting nonpregnancy, the sensitivity and specificity varied from 13% to 66% and 73% to 97%, respectively. Because of heterogeneity among studies, a summary receiver operating characteristics (ROC) curve could not be estimated. Back-to-back comparison of the CCCT with basal FSH was possible in six studies. In predicting poor response, the sensitivity of the CCCT increased to some extent, whereas specificity did not increase or even diminished. In predicting nonpregnancy, the CCCT also showed an increase in sensitivity, counteracted by a decrease in specificity. CONCLUSION(S) Summary estimates of test accuracy for the CCCT in IVF are not possible, because of heterogeneity among individual studies. A subanalysis of studies comparing basal FSH and the full CCCT showed that the CCCT has hardly any additional value.
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Affiliation(s)
- Dave J Hendriks
- Department of Reproductive Medicine, Division of Obstetrics, Neonatology and Gynecology, University Medical Center Utrecht, Utrecht, The Netherlands.
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Abstract
PURPOSE OF REVIEW In ovum donation cycles, the role of preparatory cycles to ensure proper endometrial development in the recipient remains controversial. As evidenced in the literature, endometrial receptivity is critical in conception. Therefore, endometrial preparation with exogenous hormones in addition to synchronization of the recipient and donor are essential in achieving a successful outcome. RECENT FINDINGS There are very limited data specifically examining the benefit of recipients undergoing preparatory cycles prior to their actual egg donation cycle. One study concluded that trial hormone replacement treatment cycles with endometrial biopsies may be useful in older reproductive-age women but not in younger women. Another study showed no difference in pregnancy rates between those who did and did not undergo preparatory cycles. SUMMARY Since one of the integral elements of preparatory cycles is determining endometrial dating, with relatively conflicting data, these mock cycles may not be as beneficial as expected. Therefore, for those who routinely use preparatory cycles, the potential risks, benefits, and costs of these cycles, increased hormonal exposure, the relatively invasive nature of the procedure, and time prior to performing them must be considered.
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Affiliation(s)
- Sunny H Jun
- Stanford University Medical Center, 300 Pasteur, Dr. HH333, Stanford, California 94305, USA
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Hoad CL, Raine-Fenning NJ, Fulford J, Campbell BK, Johnson IR, Gowland PA. Uterine tissue development in healthy women during the normal menstrual cycle and investigations with magnetic resonance imaging. Am J Obstet Gynecol 2005; 192:648-54. [PMID: 15696017 DOI: 10.1016/j.ajog.2004.07.032] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE High-resolution magnetic resonance imaging (MRI) was used to monitor both uterine endometrial and junctional zone morphometry during the normal menstrual cycle. STUDY DESIGN Twenty-four healthy, ovulating women were studied during a single menstrual cycle. Three scans were performed to prospectively coincide with the follicular, periovulatory, and luteal phases of the cycle. RESULTS MRI data showed a significant increase in endometrial and junctional zone volume, between the follicular and periovulatory phases, with a significant decrease in endometrial volume observed from the periovulatory to luteal phases. The regularity index, which is a novel subjective assessment of junctional zone structure, varied significantly and demonstrated a less regular junctional zone in the luteal phase. CONCLUSION This study has quantified the normal developmental changes of uterine tissue during the menstrual cycle with MRI. Junctional zone data from MRI may play a major role in future studies that investigate menstrual disorders, subfertility, and pathologic changes.
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Affiliation(s)
- Caroline L Hoad
- Sir Peter Mansfield Magnetic Resonance Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, UK
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Raine-Fenning NJ, Campbell BK, Clewes JS, Kendall NR, Johnson IR. Defining endometrial growth during the menstrual cycle with three-dimensional ultrasound. BJOG 2004; 111:944-9. [PMID: 15327609 DOI: 10.1111/j.1471-0528.2004.00214.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To define the changes in endometrial morphometry that occur during the normal menstrual cycle and to examine the discriminatory power of volumetric analysis over conventional two-dimensional measurements in quantifying the effect of compounding factors on endometrial growth. DESIGN The design was that of a longitudinal observational study. Subjects were seen on an alternate-day basis until ovulation and then every four days until the next menstrual period. SETTING A University teaching hospital. POPULATION Thirty women with regular cycles and acceptable "normal", menstrual patterns. METHODS Three-dimensional ultrasound data were acquired and subsequently analysed by a single observer. MAIN OUTCOME MEASURES Endometrial thickness and volume. RESULTS Both endometrial volume and thickness increased significantly during the follicular phase (P < 0.001), reaching a plateau around the time of ovulation and remaining relatively stable throughout the luteal phase. These changes in endometrial thickness and volume were highly correlated (R(2)= 0.767; P < 0.001). Parity was associated with a significantly greater endometrial volume than nulliparity (4.159 vs 2.234 cm(3); P < 0.05). CONCLUSIONS This study has defined the relative and absolute changes in endometrial growth, both in terms of thickness and volume, throughout the normal menstrual cycle. These data provide a reference for future three-dimensional studies investigating menstrual disorders, pathophysiological change and subfertility.
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Affiliation(s)
- Nicholas J Raine-Fenning
- School of Human Development, University of Nottingham, Queens Medical Centre, East Block, Nottingham NG7 2UH, UK
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Baerwald AR, Pierson RA. Endometrial development in association with ovarian follicular waves during the menstrual cycle. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2004; 24:453-460. [PMID: 15343603 PMCID: PMC2891966 DOI: 10.1002/uog.1123] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVES Waves of ovarian follicular development during the menstrual cycle have recently been documented in our laboratory. The objective of this study was to test the hypothesis that ultrasonographically detectable changes in the endometrium during the menstrual cycle would differ between women with two vs. three waves of ovarian follicular development and among women with different major and minor wave patterns of follicle growth. METHODS Fifty women of reproductive age (mean age +/- SD, 28.0 +/- 6.9 years) underwent daily transvaginal ultrasonography for one interovulatory interval (IOI). Ultrasonographic images of the endometrium were obtained each day, and measurements of endometrial area and perimeter (based on the shape of an ellipse, in the transverse plane) and thickness and pattern (in the sagittal plane) were recorded. Endometrial area, perimeter, thickness and pattern were compared between women with two and three waves of follicle development and among women with different minor and major wave patterns of follicular growth during the IOI. RESULTS Endometrial area, perimeter, thickness and pattern increased earlier during the follicular phase in women with two vs. three waves of follicular development. In women with two follicle waves, endometrial area and perimeter increased earlier in those with major major vs. minor major follicle wave patterns. CONCLUSIONS Ultrasonographically detectable changes in the endometrium occurred in association with follicle wave dynamics in women. Earlier development of the endometrium during the follicular phase in women with two vs. three follicle waves was attributed to an earlier increase in dominant follicle estradiol production.
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Affiliation(s)
- A R Baerwald
- Women's Health Imaging Research Laboratory, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Saskatchewan, Royal University Hospital, Saskatoon, Saskatchewan, Canada
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Pierson RA. Imaging the endometrium: are there predictors of uterine receptivity? JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2003; 25:360-8. [PMID: 12738977 DOI: 10.1016/s1701-2163(16)30578-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Ultrasound imaging technology brings new insight to cyclic changes in the endometrium and offers the potential to assess the probability of embryo implantation in natural and assisted reproduction cycles. However, the data reported are diverse and frequently conflict in their analysis and conclusions. This review examines imaging techniques used for endometrial evaluation, including grey-scale ultrasonography and colour-flow, power-flow, and spectral Doppler interrogation of the uterine vasculature. New techniques being used for uterine assessment, such as computer-assisted image analysis, three-dimensional ultrasonography, and magnetic resonance imaging, are also discussed. Each of these techniques is under active investigation and has the potential to provide rapid, noninvasive endometrial evaluation. Currently, there is reasonable certainty that women with heterogeneous endometrial linings of less than 6 mm will rarely conceive, and that endometrial contractions, or lack thereof, play some role in the successful establishment of pregnancy, even though this role has not yet been identified. Given the set of new imaging technologies available, it is feasible to expect that visual assessments will someday be used as predictors of uterine receptivity.
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Affiliation(s)
- Roger A Pierson
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Saskatchewan, Saskatoon, SK, Canada
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Shibahara H, Obara H, Hirano Y, Taneichi A, Suzuki T, Takamizawa S, Sato I. Influence of endometrial thickness and pattern on pregnancy rates in in vitro fertilization-embryo transfer. Reprod Med Biol 2002; 1:17-21. [PMID: 29699068 DOI: 10.1046/j.1445-5781.2002.00002.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Aim : Our aim was to investigate the role of endometrial thickness and pattern in the pregnancy rate during an in vitro fertilization-embryo transfer (IVF-ET) cycle. Methods : Records of patients who underwent IVF-ET at the Jichi Medical School Hospital during May 1995-December 1999 were evaluated retrospectively. Only cycles, in which endometrial thickness and pattern on the day of human chorionic gonadotrophin (HCG) administration were recorded, were analyzed in this study. Endometrial thickness was divided into three categories (A: < 10 mm, B: 10-14 mm, C: > 14 mm), and endometrial pattern was divided into two categories: triple line and non-triple line. A total of 156 IVF-ET cycles from 120 patients was evaluated. Results : There were no significant differences for both the endometrial thickness and pattern in the pregnancy rate during the IVF-ET cycle (P > 0.05). Among the study groups, the triple-line endometrial pattern was found to be 58.7% in group A, 84.0% in group B and 70% in group C. We found that in the triple-line endometrial pattern, there was a significant difference between group A and group B (P < 0.01). Triple-line endometrial pattern appeared significantly in younger women (33 ± 5.4 years) than in non-triple-line endometrial pattern (36 ± 5.2 years; P = 0.047). The minimum and maximum endometrial thickness where pregnancy occurred was 6.5 mm (two pregnancies) and 19 mm (one pregnancy), respectively. Conclusion : Endometrial thickness and pattern have no influence on the pregnancy rates in an IVF-ET cycle, but patients with triple-line endometrial pattern and group B endometrial thickness showed a better pregnancy outcome in the IVF-ET treatment. (Reprod Med Biol 2002; 1: 17-21).
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Affiliation(s)
| | - Hiroaki Shibahara
- Department of Obstetrics and Gynecology, Jichi Medical School, Tochigi, Japan
| | - Hiromi Obara
- Department of Obstetrics and Gynecology, Jichi Medical School, Tochigi, Japan
| | - Yuki Hirano
- Department of Obstetrics and Gynecology, Jichi Medical School, Tochigi, Japan
| | - Akiyo Taneichi
- Department of Obstetrics and Gynecology, Jichi Medical School, Tochigi, Japan
| | - Tatsuya Suzuki
- Department of Obstetrics and Gynecology, Jichi Medical School, Tochigi, Japan
| | - Satoru Takamizawa
- Department of Obstetrics and Gynecology, Jichi Medical School, Tochigi, Japan
| | - Ikuo Sato
- Department of Obstetrics and Gynecology, Jichi Medical School, Tochigi, Japan
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Oosterhuis GJ, Michgelsen HW, Vermes I. Laboratory markers of ovarian function. Adv Clin Chem 2001; 35:295-331. [PMID: 11040962 DOI: 10.1016/s0065-2423(01)35019-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- G J Oosterhuis
- Medisch Spectrum Twente Hospital Group, Enschede, The Netherlands
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Women's Health LiteratureWatch. JOURNAL OF WOMEN'S HEALTH & GENDER-BASED MEDICINE 1999; 8:1121-7. [PMID: 10565672 DOI: 10.1089/jwh.1.1999.8.1121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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