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Thin unresponsive endometrium—a possible complication of surgical curettage compromising ART outcome

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Abstract

Purpose

Endometrial thickness is important for implantation. Little data addresses the etiology of persistently thin endometrium. We present a patient cohort in order to define common features and draw conclusions.

Methods

Thirteen out of 1,405 IVF patients repeatedly had thin unresponsive endometrium (<7 mm). Age, history, uterine cavity status, treatment type and outcome were examined.

Results

Patient age was 35.9 ± 5.7 years. Ten patients had a curettage performed previously. Nine patients had normal cavity and endometrium, and in four adhesions were diagnosed and removed. Out of 99 cycles performed afterwards, endometrial thickness increased in 22. ETs were performed in 49 cycles resulting in 11 pregnancies. Their outcome was eight miscarriages, two terminations due to malformations, and one live birth.

Conclusions

Thin unresponsive endometrium was associated with curettage, not necessarily with intrauterine adhesions. Even if adequate thickening eventually occurred, the reproductive outcome was still very poor. Therefore other alternatives should be sought for these patients.

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References

  1. 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;71:624–8. doi:10.3109/00016349209006231.

    Article  PubMed  CAS  Google Scholar 

  2. Check JH, Nowroozi K, Choe J, Dietterich C. Influence of endometrial thickness and echo patterns on pregnancy rates during in vitro fertilization. Fertil Steril 1991;56:1173–5.

    PubMed  CAS  Google Scholar 

  3. Dickey RP, Olar TT, Curole DN, Taylor SN, Rye PH. Endometrial pattern and thickness associated with pregnancy outcome after assisted reproduction technologies. Hum Reprod 1992;7:418–21.

    PubMed  CAS  Google Scholar 

  4. Gonen Y, Casper RF, Jacobson W, Blankier J. Endometrial thickness and growth during ovarian stimulation: a possible predictor of implantation in in vitro fertilization. Fertil Steril 1989;52:446–50.

    PubMed  CAS  Google Scholar 

  5. Noyes N, Liu HC, Sultan K, Schattman G, Rosenwaks Z. Endometrial thickness appears to be a significant factor in embryo implantation in in-vitro fertilization. Hum Reprod 1995;10:919–22.

    PubMed  CAS  Google Scholar 

  6. Sher G, Herbert C, Maassarani G, Jacobs MH. Assessment of the late proliferative phase endometrium by ultrasonography in patients undergoing in-vitro fertilization and embryo transfer (IVF/ET). Hum Reprod 1991;6:232–7.

    PubMed  CAS  Google Scholar 

  7. Zenke U, Chetkowski RJ. Transfer and uterine factors are the major recipient-related determinants of success with donor eggs. Fertil Steril 2004;82:850–6. doi:10.1016/j.fertnstert.2004.03.057.

    Article  PubMed  Google Scholar 

  8. Hassan HA, Saleh HA. Endometrial unresponsiveness: a novel approach to assessment and prognosis in in vitro fertilization cycles. Fertil Steril 1996;66:604–7.

    PubMed  CAS  Google Scholar 

  9. De Geyter C, Schmitter M, De Geyter M, Nieschlag E, Holzgreve W, Schneider HP. Prospective evaluation of the ultrasound appearance of the endometrium in a cohort of 1,186 infertile women. Fertil Steril 2000;73:106–13. doi:10.1016/S0015-0282(99)00484-7.

    Article  PubMed  Google Scholar 

  10. Fleischer AC, Herbert CM, Sacks GA, Wentz AC, Entman SS, James AE Jr. Sonography of the endometrium during conception and nonconception cycles of in vitro fertilization and embryo transfer. Fertil Steril 1986;46:442–7.

    PubMed  CAS  Google Scholar 

  11. Glissant A, de Mouzon J, Frydman R. Ultrasound study of the endometrium during in vitro fertilization cycles. Fertil Steril 1985;44:786–90.

    PubMed  CAS  Google Scholar 

  12. Khalifa E, Brzyski RG, Oehninger S, Acosta AA, Muasher SJ. Sonographic appearance of the endometrium: the predictive value for the outcome of in-vitro fertilization in stimulated cycles. Hum Reprod 1992;7:677–80.

    PubMed  CAS  Google Scholar 

  13. Oliveira JB, Baruffi RL, Mauri AL, Petersen CG, Campos MS, Franco JG Jr. Endometrial ultrasonography as a predictor of pregnancy in an in-vitro fertilization programme. Hum Reprod 1993;8:1312–5.

    PubMed  CAS  Google Scholar 

  14. Welker BG, Gembruch U, Diedrich K, al-Hasani S, Krebs D. Transvaginal sonography of the endometrium during ovum pickup in stimulated cycles for in vitro fertilization. J Ultrasound Med 1989;8:549–53.

    PubMed  CAS  Google Scholar 

  15. 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;11:1538–41.

    PubMed  CAS  Google Scholar 

  16. Zhang X, Chen CH, Confino E, Barnes R, Milad M, Kazer RR. Increased endometrial thickness is associated with improved treatment outcome for selected patients undergoing in vitro fertilization–embryo transfer. Fertil Steril 2005;83:336–40. doi:10.1016/j.fertnstert.2004.09.020.

    Article  PubMed  Google Scholar 

  17. Friedler S, Schenker JG, Herman A, Lewin A. The role of ultrasonography in the evaluation of endometrial receptivity following assisted reproductive treatments: a critical review. Hum Reprod Update 1996;2:323–35. doi:10.1093/humupd/2.4.323.

    Article  PubMed  CAS  Google Scholar 

  18. Sundstrom P. Establishment of a successful pregnancy following in-vitro fertilization with an endometrial thickness of no more than 4 mm. Hum Reprod 1998;13:1550–2. doi:10.1093/humrep/13.6.1550.

    Article  PubMed  CAS  Google Scholar 

  19. Rijnders PM, Jansen CA. The predictive value of day 3 embryo morphology regarding blastocyst formation, pregnancy and implantation rate after day 5 transfer following in-vitro fertilization or intracytoplasmic sperm injection. Hum Reprod 1998;13:2869–73.

    PubMed  CAS  Google Scholar 

  20. Senturk LM, Erel CT. Thin endometrium in assisted reproductive technology. Curr Opin Obstet Gynecol 2008;20:221–8. doi:10.1097/GCO.0b013e328302143c.

    Article  PubMed  Google Scholar 

  21. Barash A, Dekel N, Fieldust S, Segal I, Schechtman E, Granot I. Local injury to the endometrium doubles the incidence of successful pregnancies in patients undergoing in vitro fertilization. Fertil Steril 2003;79:1317–22. doi:10.1016/S0015-0282(03)00345-5.

    Article  PubMed  Google Scholar 

  22. Raziel A, Schachter M, Strassburger D, Bern O, Ron-El R, Friedler S. Favorable influence of local injury to the endometrium in intracytoplasmic sperm injection patients with high-order implantation failure. Fertil Steril 2007;87:198–201. doi:10.1016/j.fertnstert.2006.05.062.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. IVF Unit, The Department of Obstetrics and Gynecology, Hadassah University Hospital, Ein Kerem, P.O. Box 12000, Jerusalem, 91120, Israel

    Yoel Shufaro, Alex Simon, Neri Laufer & Muhammad Fatum

Authors
  1. Yoel Shufaro
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  2. Alex Simon
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  3. Neri Laufer
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  4. Muhammad Fatum
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Corresponding author

Correspondence to Yoel Shufaro.

Additional information

Capsule Thin unresponsive endometrium without adhesions is associated with past surgical curettage procedures and results in a very poor reproductive outcome.

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Shufaro, Y., Simon, A., Laufer, N. et al. Thin unresponsive endometrium—a possible complication of surgical curettage compromising ART outcome. J Assist Reprod Genet 25, 421–425 (2008). https://doi.org/10.1007/s10815-008-9245-y

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  • DOI: https://doi.org/10.1007/s10815-008-9245-y

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