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Effect of Thin Endometrium Lining in Egg Donor Recipients on Egg Donation Pregnancy Success Rates

Research presentation by Dr. Sherbahn at the 2011 Annual Meeting of the American Society for Reproductive Medicine in Orlando, FL

Author: Richard Sherbahn, MD

.
  • Normal endometrial thickness in a natural menstrual cycle is usually 8 to 12 mm
  • Successful pregnancy requires both a quality embryo and a receptive uterus
  • Therefore, both uterine problems and embryo quality problems can cause infertility
  • The problem could be the "plant" (embryo) - or the "garden" (uterus)
  • The problem is much more likely to be the plant than the garden

There is not agreement in the medical literature about the impact of a thin uterine lining on pregnancy success rates with egg donation. Some studies have shown that a thin endometrial lining is associated with a lower chance of success. Other studies have shown no difference in success rates with thin, normal or thick uterine endometrium.

Our study was performed to further investigate the relationship between the thickness of the uterine endometrium and pregnancy success using donor eggs.

Objective:

  • This study was designed to investigate the influence of the egg donation recipient's lining thickness on egg donation success

Materials and Methods:

  • Retrospective review of implantation and pregnancy rates according to recorded factors in our egg donor database.
  • All 339 egg donation cycles with a maximal endometrial thickness recorded and a fresh embryo transfer between January 2005 and March 2011 were included.
  • Outcomes were compared using:
    • Implantation rates (number of fetal hearts on ultrasound divided by number of embryos transferred)
    • Clinical pregnancy rates (percentage of transfer procedures resulting in fetal heart activity seen on ultrasound)
  • Statistical analysis utilized Student's t-test and chi-square statistics. Significance was defined as p<0.05.

The cases were split into 2 groups for analysis:

  • Endometrial thickness of 5.9 to 7.9mm
  • Uterine lining thickness of 8 to 23mm

Results:

Implantation rates

Implantation Rate by Uterine Endometrium Group

 

Cycles

Average thickness

Lining 5.9 - 7.9 mm

40

7.1 mm

Lining 8.0 – 23 mm

299

10.4 mm

Continued

Implantation Rate by Uterine Endometrium Group

Fetal hearts / embryos transferred

Implantation Rate

P value

48 / 77

62.3%

0.79

351 / 578

60.7%

Implantation Rate by Uterine Endometrium Group

 

Cycles

Average thickness

Fetal hearts / embryos transferred

Implantation Rate

P value

Lining 5.9 - 7.9 mm

40

7.1 mm

48 / 77

62.3%

0.79

Lining 8.0 – 23 mm

299

10.4 mm

351 / 578

60.7%


Lining thickness and egg donation success


Clinical pregnancy rates

  • Clinical pregnancy rates per transfer were similar in the 2 endometrial thickness groups (p = 0.92).
  • The clinical pregnancy rates were slightly higher in the thinner uterine wall group at 77.5% than in the thicker lining group - 76.6%
  • However, this difference was not statistically significant

Clinical Pregnancy Rate Per Transfer by Uterine Endometrium Group

 

Cycles

Average thickness

Lining 5.9 - 7.9 mm

40

7.1mm

Lining 8.0 – 23 mm

299

10.4mm

Continued

Clinical Pregnancy Rate Per Transfer by Uterine Endometrium Group

Pregnant cycles / Total cycles

Clinical Pregnancy Rate

P value

31 / 40

77.5%

0.92

229 / 299

76.6%

Clinical Pregnancy Rate Per Transfer by Uterine Endometrium Group

 

Cycles

Average thickness

Pregnant cycles / Total cycles

Clinical Pregnancy Rate

P value

Lining 5.9 - 7.9 mm

40

7.1mm

31 / 40

77.5%

0.92

Lining 8.0 – 23 mm

299

10.4mm

229 / 299

76.6%


Uterine lining thickness and egg donation success


Conclusions:

  • There is not universal agreement in the literature about the impact of endometrial thickness on uterine receptivity and IVF and egg donation success rates
  • Our study shows no significant difference in implantation rates or pregnancy rates according to the thickness of the recipient's endometrium
  • Further study is needed on egg donation outcomes with a thin endometrium under 7mm to determine how thin is too thin

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