Influences on endometrial development during intrauterine insemination: clinical experience of 2,929 patients with unexplained infertility

There is increasing awareness of the importance of endometrial development in infertile patients. In a large unexplained infertility population, we describe the factors affecting adverse endometrial development during IUI cycles.

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Authors

Erin Foran Wolff, M.D., Nima Vahidi, Connie Alford, M.D., Kevin Richter, Ph.D., Eric Widra, M.D.

Volume 100, Issue 1, Pages 194-199.e1, July 2013

Abstract

Objective:

To characterize relationships associated with adverse endometrial development in patients undergoing IUI for unexplained infertility.

Design:

A retrospective review of 2,929 patients from 2004–2011.

Setting:

Large metropolitan infertility practice.

Patient(s):

Patients with unexplained infertility undergoing first IUI cycle at age less than 43 years, with a total motile sperm count ≥8 million.

Intervention(s):

Clomiphene citrate (CC) with FSH stimulation followed by IUI.

Main Outcome Measure(s):

Endometrial thickness, serum E2 (in picograms per milliliter) levels on the day of hCG trigger administration, body mass index (BMI) (in kilograms per meter squared), total motile sperm, follicle number, and clinical pregnancy.

Result(s):

Of the 2,929 patients who met the inclusion criteria, 466 (15.9 %) achieved a clinical pregnancy. Pregnancy rates (PRs) increased significantly with increasing endometrial thickness on the day of hCG administration and with increasing serum E2 level, but were not significantly related to age, BMI, or follicle numbers according to multiple logistic regression modeling. Peak endometrial thickness declined with age and increasing E2 levels. The BMI was associated with thicker endometrium, but it was also associated with lower peak E2 levels.

Conclusion(s):

The impact of “endometrial factor” infertility may be underappreciated in IUI therapy. Targeted therapies to optimize the endometrium represent an important new area to improve in current fertility success rates.

Read the full text at: http://www.fertstert.org/article/S0015-0282(13)00424-X/fulltext


Fertility and Sterility

Editorial Office, American Society for Reproductive Medicine

Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders. The journal publishes juried original scientific articles in clinical and laboratory research relevant to reproductive endocrinology, urology, andrology, physiology, immunology, genetics, contraception, and menopause. Fertility and Sterility® encourages and supports meaningful basic and clinical research, and facilitates and promotes excellence in professional education, in the field of reproductive medicine.

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