Abstract

ROLE OF ENDOMETRIAL THICKNESS OPTIMIZATION IN THE PREGNANCY RATE FOR INFERTILE WOMEN UNDERGOING IUI USING DIFFERENT OVULATION INDUCTION PROTOCOLS

Nidhal Hussein Ali Alsultan D.G.O, Muhammad Baqir MR Fakhrildin Ph.D, Mohammad Oda Selman*

Abstract

Background: Many studies have been carried out to determine the effect of endometrial thickness on the success of implantation and pregnancy outcome, whereas cutoff value of thickness producing successful pregnancy and the factors affecting the endometrial thickness still need more studies. Objective: To investigate the effect of endometrial thickness on pregnancy outcome for IUI patients using different ovulation induction programs. Materials and Methods: This study was conducted as randomized prospective study on 124 infertile couples considered for intrauterine insemination (IUI) during their attendance to High Institute of Infertility Diagnosis and ART at ALNahrain University and Kamal Al-Samarai Hospital Center of Fertility and IVF and from private clinic of obstetric and gynecology through the period from September 2014 to May 2015. IUI programs were sequential regimen of Clomiphene citrate, Gonadotropin, Letrozol and Tamoxifen. Endometrial thickness measurement was assessed by ultrasound on the cycle day 12 before HCG administration. Correlation between endometrial thickness and factors such as age, number and size of dominant follicle, sperm quality and pregnancy rate were assessed. Results: The overall pregnancy rate was 16%. Mean of the endometrial thickness on the day before hCG administration was significantly greater in cycles where pregnancy was achieved (8.86 mm). The study identified a statistically significant difference in mean endometrial thickness between cycles that resulted in pregnancy and those that did not. No significant correlation between various ovulation induction programs and pregnancy rate after IUI. The following variables affected the pregnancy rate: the woman's age, follicular size, duration of infertility, sperm count, motility and morphology. The woman's age was negatively associated with pregnancy outcome, while endometrial thickness and the total motile sperm count were positively associated with pregnancy rate. Conclusion: Results of the present study suggested that the mean endometrial thickness is significantly higher in pregnant compared to nonpregnant women. The physicians providing IUI for infertile couples must pay close attention to endometrial thickness, as well as to ovarian follicle growth and sperm motility.

Keywords: Endometrial thickness. Intrauterine insemination. Pregnancy rate.