Defining the proliferative phase endometrial defect.
OBJECTIVE
To evaluate proliferative phase endometrial development in a heterogeneous infertility population.


METHODS
Retrospective study.


METHODS
University-based infertility practice.


METHODS
Two hundred forty-six treatment cycles.


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


METHODS
Endometrial thickness according to transvaginal ultrasonography; clinical pregnancy rate.


RESULTS
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 E(2) 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).


CONCLUSIONS
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.
Bromer
Jason G
JG
Department of Obstetrics, Division of Reproductive Endocrinology and Infertility, Yale University School of Medicine, New Haven, Connecticut 06520, USA.
Aldad
Tamir S
TS
Taylor
Hugh S
HS
D000026:Abortion, Habitual / Q000503:physiopathology; D000328:Adult; D002996:Clomiphene / Q000627:therapeutic use*; D004715:Endometriosis / Q000150:complications / Q000503:physiopathology; D004717:Endometrium / Q000000981:diagnostic imaging / Q000187:drug effects* / Q000503:physiopathology; D005260:Female; D005300:Fertility Agents, Female / Q000627:therapeutic use*; D005307:Fertilization in Vitro; D005640:Follicle Stimulating Hormone / Q000627:therapeutic use*; D005498:Follicular Phase / Q000187:drug effects*; D006801:Humans; D007247:Infertility, Female / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D007315:Insemination, Artificial; D008875:Middle Aged; D010062:Ovulation Induction / Q000379:methods*; D011085:Polycystic Ovary Syndrome / Q000150:complications / Q000503:physiopathology; D011247:Pregnancy; D018873:Pregnancy Rate; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography; D055815:Young Adult
D005300:Fertility Agents, Female; D002996:Clomiphene; D005640:Follicle Stimulating Hormone