title: Thin unresponsive endometrium--a possible complication of surgical curettage compromising ART outcome.
abstract: OBJECTIVE
  Endometrial thickness is important for implantation. Little data addresses the etiology of persistently thin endometrium. We present a patient cohort in order to define common features and draw conclusions.
  
  
  METHODS
  Thirteen out of 1,405 IVF patients repeatedly had thin unresponsive endometrium (<7 mm). Age, history, uterine cavity status, treatment type and outcome were examined.
  
  
  RESULTS
  Patient age was 35.9 +/- 5.7 years. Ten patients had a curettage performed previously. Nine patients had normal cavity and endometrium, and in four adhesions were diagnosed and removed. Out of 99 cycles performed afterwards, endometrial thickness increased in 22. ETs were performed in 49 cycles resulting in 11 pregnancies. Their outcome was eight miscarriages, two terminations due to malformations, and one live birth.
  
  
  CONCLUSIONS
  Thin unresponsive endometrium was associated with curettage, not necessarily with intrauterine adhesions. Even if adequate thickening eventually occurred, the reproductive outcome was still very poor. Therefore other alternatives should be sought for these patients.
authors.affiliation: IVF Unit, The Department of Obstetrics and Gynecology, Hadassah University Hospital, Ein Kerem, Jerusalem, Israel. yoelsh@ekmd.huji.ac.il
authors.forename: Yoel
authors.initials: Y
authors.lastname: Shufaro
authors.forename: Alex
authors.initials: A
authors.lastname: Simon
authors.forename: Neri
authors.initials: N
authors.lastname: Laufer
authors.forename: Muhammad
authors.initials: M
authors.lastname: Fatum
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003475:Curettage / Q000009:adverse effects* / Q000379:methods*; D010064:Embryo Implantation; D004624:Embryo Transfer; D004714:Endometrial Hyperplasia; D004717:Endometrium / Q000473:pathology*; D005260:Female; D005307:Fertilization in Vitro / Q000009:adverse effects / Q000379:methods; D006801:Humans; D011183:Postoperative Complications; D011247:Pregnancy; D011256:Pregnancy Outcome; D027724:Reproductive Techniques, Assisted; D000267:Tissue Adhesions
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