International Journal of Infertility & Fetal Medicine

Register      Login

VOLUME 3 , ISSUE 2 ( May-August, 2012 ) > List of Articles


Is Endometrial Thickness on the Day of ET Really Predictive of IVF Outcome?

MS Srinivas, Richa Sharma, Theodre Jones

Citation Information : Srinivas M, Sharma R, Jones T. Is Endometrial Thickness on the Day of ET Really Predictive of IVF Outcome?. Int J Infertil Fetal Med 2012; 3 (2):40-47.

DOI: 10.5005/jp-journals-10016-1039

License: CC BY-NC 4.0

Published Online: 01-04-2015

Copyright Statement:  Copyright © 2012; The Author(s).



The effect of endometrial thickness on pregnancy rates in assisted reproductive technology (ART) patients has been evaluated by many authors, with controversial results. Endometrial thickness has been utilized as an indirect indicator for endometrial receptivity.


To evaluate relationship between endometrial thickness on day of embryo transfer and pregnancy outcome in in vitro fertilization and embryo transfer (IVF-ET) cycles. Should we cancel cycles based on endometrial thickness only?

Material and methods

A prospective analysis was conducted at Dr Kamini Rao Hospital, Bangaluru, of 239 patients. Various parameters were compared between pregnant and nonpregnant patients to see whether there is any cut-off for endometrial thickness on day of embryo transfer by which we can predict good prognosis in form of pregnancy and what effect other variables on endometrial thickness and pregnancy respectively and should we cancel embryo transfer, if endometrial thickness is not within certain range?


In the study population, 174 (73%) had primary and 65 (27%) had secondary infertility, Ovarian stimulation was performed with long protocol in 37% cases, antagonist protocol in 47% and other protocols like microflare, short, ultralong, ultrashort in 15%. Mean age of patients was 31.04 ± 3.79 years. Among causes of infertility male factor was present in 39%, tubal factor was seen in 18%, unexplained were 13%, polycystic ovarian syndrome in 11%, poor ovarian reserve in 4.1% and mixed causes in 13%. Majority of our patients were in normal and overweight as per body mass index (BMI). ET were easy in 90% of cases and 14 (5.8%) ETs were cancelled. The reason for cancellation was ovarian hyperstimulation syndrome (OHSS) in 9 cases, fluid in cavity in 2 cases, one patient had hyperpyrexia on day of ET and 2 cases of failed fertilization. Endometrial thickness was >10 mm in 35% cases. Overall clinical pregnancy rate was 39% with implantation rate of 21%, fertilization rate of 92% and cleavage rate of 95% and live birth rate of 26%. There were more follicles, oocytes and embryos, the endometrium was >10 mm and embryo quality was higher among women who became pregnant when compared with nonpregnant women after assisted reproduction though not statistically significant (p > 0.05). The pregnancy rate improved as endometrial thickness increased showing a linear association.


Increased endometrial thickness is associated with higher pregnancy rates, but as such a cut off cannot be decided. In our study we have seen pregnancies at both thin and thick endometrium so we should not cancel ET merely on the basis of endometrial thickness as pregnancy is affected by multiple variables and not by endometrial thickness alone.

How to cite this article

Sharma R, Rao K, Srinivas MS, Jones T. Is Endometrial Thickness on the Day of ET Really Predictive of IVF Outcome? Int J Infertility Fetal Med 2012;3(2): 40-47.

PDF Share
  1. The role of ultrasonography in the endometrial receptivity following assisted reproduction treatmens: A critical review. Hum Reprod Update 1996;2:323-35.
  2. Endometrial thickness is a valid monitoring parameter in cycles of ovulation induction with menotropins alone. Fertil Steril 1996;65:262-66.
  3. Endometrial thickness appears to be a significant factor in embryo implantation in in vitro fertilization. Hum Reprod 1995; 10:919-22.
  4. Endometrial thickness as a predictor of pregnancy after in vitro fertilization but not after intracytoplasmic sperm injection. Hum Reprod 1996;11:1538-41.
  5. The relationships between endometrial thickness, and blood flow and pregnancy rates in invitro fertilization. Hum Reprod 1999;14:1067-71.
  6. The detrimental effect of increased endometrial thickness on implantation and pregnancy rates and outcome in an in vitro fertilization program. Fertil Steril 1999;71:147-49.
  7. Prospective evaluation of the ultrasound appearance of the endometrium in a cohort of 1,186 infertile women. Fertil Steril 2000;73:106-13.
  8. Changes in endometrial thickness, thickness, length and pattern in predicting pregnancy outcome during ovarian stimulation in in vitro fertilization. Ultrasound Obstet Gynecol 2001;18:258-63.
  9. Endometrial receptivity in an in vitro fertilization program as assessed by spiral artery blood flow, endometrial thickness, endometrial volume and uterine artery blood flow. Fertil Steril. Fertil Steril 2001;75:361-66.
  10. The effect of endometrial thickness on IVF/ICSI outcome. Hum Reprod 2003;18:2337-41.
  11. Influence of endometrial thickness and echo patterns on pregnancy rates during in vitro fertilization. Fertil Steril 1991;56:1173-75.
  12. Endometrial pattern and thickness associated with pregnancy outcome after assisted reproduction technologies. Hum Reprod 1992;7:418-21.
  13. Endometrial thickness and growth during ovarian stimulation: A possible predictor of implantation in in vitro fertilization. Fertil Steril 1989;52:446-50.
  14. Prediction of implantation by the sonographic appearance of the endometrium during controlled ovarian stimulation for in vitro fertilization (IVF). J In Vitro Fert Embryo Transfer 1990;7:146-52.
  15. Changes in measured endometrial thickness predict in vitro fertilization success. Fertil Steril 2007;88:74-81.
  16. Increased endometrial thickness is associated with improved treatment outcome for selected patients undergoing in vitro fertilization–embryo transfer. Fertil Steril 2005;83: 336-40.
  17. The effect of endometrial thickness and echo pattern on in vitro fertilization outcome in donor oocyte-embryo transfer cycle. Fertil Steril 1993;59:72-75.
  18. Significance of increased endometrial thickness in assisted reproduction technology treatments. J Assist Reprod Genet 2004;21:285-89.
  19. Successful pregnancies in the setting of exaggerated endometrial thickness. Fertil Steril 2004;82:215-17.
  20. Are endometrial parameters by three-dimensional ultrasound and power Doppler angiography related to in vitro fertilization/embryo transfer outcome? American Society for Reproductive Medicine. Fertil Steril_ 2008;89:111-17.
  21. Increased endometrial thickness on the day of human chorionic gonadotropin injection does not adversely affect pregnancy or implantation rates following in vitro fertilization-embryo transfer. Fertil Steril 2002;77:781-86.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.