Sonographic assessment of endometrial pattern and thickness in patients treated with human menopausal gonadotropins

Objective: To analyze sonographically the endometrium in patients undergoing controlled ovarian stimulation with menotropins in order to determine the significance of endometrial pattern and thickness on pregnancy rate. Design: This is a prospective, nonrandomized study comparing pregnancy rates in patients with hyperechoic homogeneous patterns with those in patients with isoechoic or hypoechoic trilaminar patterns. Setting: Tertiary infertility center. Patients: All patients receiving menotropin therapy at a tertiary infertility center. Interventions: All patients received individualized dosing of hMG starting on cycle day 3. Transvaginal sonography was performed 15 hours before hCG administration and the endometrium was assessed. Main Outcome Measure: Occurrence of pregnancy as determined by serially rising beta-hCG titers and sonographic confirmation. Results: During the study period, 175 patients were evaluated. Thirty-four (19%) patients had a homogeneous endometrium, whereas 141 (81%) patients had a trilaminar pattern. There was 1 pregnancy(2.9%) among women with a homogeneous endometrial pattern and 33 pregnancies (23%) among those with a trilaminar pattern. No significant differences were found in mean E(2) level, follicle numbers, parity, and diagnosis between the two groups. Conclusion: In patients receiving menotropins, a homogeneous pattern is a bad prognostic sign, regardless of endometrial thickness.