effect on assisted reproductive technology (ART) success, based on analysis of 1,552 IVF/ICSI cycles. M. Kavrut, G. Karlikaya, H. Karagozoglu, A. Ersahin, ...
Predicting factors for endometrial thickness and its effect on assisted reproductive technology (ART) success, based on analysis of 1,552 IVF/ICSI cycles M. Kavrut, G. Karlikaya, H. Karagozoglu, A. Ersahin, M. Acet,S. Kahraman Memorial Hospital, ART and Genetics Center, Istanbul, Turkey DOI: http://dx.doi.org/10.1016/j.fertnstert.2008.07.522 OBJECTIVE: The purpose of this study was to evaluate the possible relationships between endometrial thickness and clinical outcome of IVF/ICSI treatment, and investigate predicting factors for endometrial thickness retrospectively. DESIGN: Retrospective cohort study. MATERIALS AND METHODS: A retrospective analysis was conducted of 1,552 IVF/ICSI cycles between January 1, 2006 December 31, 2006. Cycles were divided into four groups based on endometrial thickness, for statistical analyses we used Pearson correlations, ROC, Multiple logistic regression analyses and Chisquare. The main outcome measures were endometrial thickness, implantation rates (IR), miscarriage rates (MR), pregnancy (PR) and clinical pregnancy rates (CPR) and live birth rate (LBR). RESULTS: Endometrial thickness decreased as age increased especially below 40 years, endometrial thickness was higher in long protocol than antagonist protocol and also higher in male factor infertility than other etiologies. The pregnancy rate improved as endometrial thickness increased. There was marginally significant trend toward decreasing rates of missed abortion with increasing endometrial thickness. We found 5% percentile endometrial thickness at 7 mm and 95% percentile at 14 mm. When we take 7 mm endometrial thickness as a cutoff level for predicting pregnancy, sensitivity was 97,9% but spesitivity was 3,9% and positive predictive value was 56% negative predictive value 60% (p=0.047).
Table 1Treatment outcome according to endometrial thickness
below 6mm
6-8 mm
8,1-14 mm
above 14mm
P value
LBR
-
11/111=0,10
189/1297=0.15
17/131=0,13
0,37
CPR
2/13=0,15
48/111=0,43
653/1297=0,50
69/131=0,52
0,034
PR
3/13=0,23
55/111=0,49
724/1297=0,56
79/131=0,60
0,038
MR
0/13=0
14/111=0,13
87/1297=0,06
6/131=0,05
0,049
IR
2/20=0,10
49/265=0,19
837/3235=0,26
96/319=0,30
0,004
CONCLUSIONS: Increased endometrial thickness is associated with improved treatment outcome but this association was dependent on patient age, etiology of infertility, stimulation protocol, peak E2 level and number of oocyte. Endometrial thickness was negatively influenced by age and positively influenced by oestradiol level. No adverse effect of a thickened endometrium was demonstrated on pregnancy rates in IVF/ICSI cycles. The sensitivity of endometrial thickness predicting pregnancy is high but the spesivity is low.
