Defining the proliferative phase endometrial defect

Objective

To evaluate proliferative phase endometrial development in a heterogeneous infertility population.

Design

Retrospective study.

Setting

University-based infertility practice.

Patient(s)

Two hundred forty-six treatment cycles.

Intervention(s)

Clomiphene citrate or FSH ovarian stimulation, followed by IUI or IVF.

Main Outcome Measure(s)

Endometrial thickness according to transvaginal ultrasonography; clinical pregnancy rate.

Result(s)

Endometrial growth began from a nadir of approximately 4.5 mm on cycle day 4 and increased linearly to a plateau of approximately 10 mm on cycle day 9. This same pattern was observed in all cycles, regardless of pregnancy, drug, or underlying diagnosis. Follicle-stimulating hormone–stimulated cycles showed a significantly increased endometrial thickness compared with clomiphene citrate cycles (10.1 vs. 8.3 mm). Maximum endometrial thickness achieved showed a correlation with age, body mass index, and maximum E₂ level. Subjects who carried a primary diagnosis of polycystic ovary syndrome, endometriosis, or recurrent pregnancy loss all achieved a significantly lower peak endometrial thickness than control subjects. There was a trend toward increased endometrial thickness in cycles resulting in pregnancy compared with those not (10.1 vs. 9.6 mm, respectively).

Conclusion(s)

Endometrial development follows a predictable pattern, with a plateau in growth at cycle day 9. Diseases associated with infertility manifest a proliferative phase defect that can be recognized clinically.

Key Words: Endometrium, endometrial development, proliferative phase, clomiphene, FSH, endometriosis, polycystic ovary syndrome, recurrent pregnancy loss