TY - JOUR
T1 - Endometrial thickness after ovarian stimulation with gonadotropin, clomiphene, or letrozole for unexplained infertility, and association with treatment outcomes
AU - Eunice Kennedy Shriver National Institute of Child Health and Human Development Reproductive Medicine Network
AU - Quaas, Alexander M.
AU - Gavrizi, Sarah Z.
AU - Peck, Jennifer D.
AU - Diamond, Michael P.
AU - Legro, Richard S.
AU - Robinson, Randal D.
AU - Casson, Peter
AU - Christman, Gregory M.
AU - Zhang, Heping
AU - Hansen, Karl R.
N1 - Publisher Copyright:
© 2020 American Society for Reproductive Medicine
PY - 2021/1
Y1 - 2021/1
N2 - Objective: To study the association of endometrial thickness (EMT) with live birth rates (LBR) in ovarian stimulation with intrauterine insemination (OS-IUI) treatments for unexplained infertility. Design: Prospective cohort analysis of the Reproductive Medicine Network's Assessment of Multiple Intrauterine Gestations from Ovarian Stimulation (AMIGOS) randomized controlled trial. Setting: Multicenter randomized controlled trial. Patients: A total of 868 couples with unexplained infertility (n=2,459 cycles). Interventions: OS-IUI treatment cycles (n = 2,459) as part of the AMIGOS clinical trial. Main Outcome Measures: Live birth rates; unadjusted and adjusted risk ratios (RR) for live birth by EMT category, calculated using generalized estimating equations. Results: The overall mean EMT on day of human chorionic gonadotropin administration in cycles with a live birth was significantly greater than in those without. Compared to the referent EMT group of 9 to 12 mm, the unadjusted RR for live birth for the EMT groups of ≤5 and 6-8 were 0.48 and 0.92, respectively. The test for trend indicated evidence of decreasing LBR with decreasing EMT. After adjustment for ovarian stimulation medication, a linear trend was no longer supported. Stratified analyses revealed no differences in associations by treatment group. Conclusions: In OS-IUI for unexplained infertility, higher LBR are observed with increasing EMT; however, EMT is not significantly associated with LBR when adjusted for OS treatment type. Appreciable LBR are seen at all EMT, even those of ≤5 mm, suggesting that OS-IUI cycles should not be canceled for thin endometrium. Clinical Trial Registration Number: NCT01044862.
AB - Objective: To study the association of endometrial thickness (EMT) with live birth rates (LBR) in ovarian stimulation with intrauterine insemination (OS-IUI) treatments for unexplained infertility. Design: Prospective cohort analysis of the Reproductive Medicine Network's Assessment of Multiple Intrauterine Gestations from Ovarian Stimulation (AMIGOS) randomized controlled trial. Setting: Multicenter randomized controlled trial. Patients: A total of 868 couples with unexplained infertility (n=2,459 cycles). Interventions: OS-IUI treatment cycles (n = 2,459) as part of the AMIGOS clinical trial. Main Outcome Measures: Live birth rates; unadjusted and adjusted risk ratios (RR) for live birth by EMT category, calculated using generalized estimating equations. Results: The overall mean EMT on day of human chorionic gonadotropin administration in cycles with a live birth was significantly greater than in those without. Compared to the referent EMT group of 9 to 12 mm, the unadjusted RR for live birth for the EMT groups of ≤5 and 6-8 were 0.48 and 0.92, respectively. The test for trend indicated evidence of decreasing LBR with decreasing EMT. After adjustment for ovarian stimulation medication, a linear trend was no longer supported. Stratified analyses revealed no differences in associations by treatment group. Conclusions: In OS-IUI for unexplained infertility, higher LBR are observed with increasing EMT; however, EMT is not significantly associated with LBR when adjusted for OS treatment type. Appreciable LBR are seen at all EMT, even those of ≤5 mm, suggesting that OS-IUI cycles should not be canceled for thin endometrium. Clinical Trial Registration Number: NCT01044862.
KW - Unexplained infertility
KW - endometrial thickness
KW - intrauterine insemination
KW - live birth
KW - ovarian stimulation
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U2 - 10.1016/j.fertnstert.2020.07.030
DO - 10.1016/j.fertnstert.2020.07.030
M3 - Article
C2 - 32972733
AN - SCOPUS:85091217246
SN - 0015-0282
VL - 115
SP - 213
EP - 220
JO - Fertility and sterility
JF - Fertility and sterility
IS - 1
ER -
