title: Influences on endometrial development during intrauterine insemination: clinical experience of 2,929 patients with unexplained infertility.
abstract: OBJECTIVE
  To characterize relationships associated with adverse endometrial development in patients undergoing IUI for unexplained infertility.
  
  
  METHODS
  A retrospective review of 2,929 patients from 2004-2011.
  
  
  METHODS
  Large metropolitan infertility practice.
  
  
  METHODS
  Patients with unexplained infertility undergoing first IUI cycle at age less than 43 years, with a total motile sperm count ≥ 8 million.
  
  
  METHODS
  Clomiphene citrate (CC) with FSH stimulation followed by IUI.
  
  
  METHODS
  Endometrial thickness, serum E2 (in picograms per milliliter) levels on the day of hCG trigger administration, body mass index (BMI) (in kilograms per meter squared), total motile sperm, follicle number, and clinical pregnancy.
  
  
  RESULTS
  Of the 2,929 patients who met the inclusion criteria, 466 (15.9 %) achieved a clinical pregnancy. Pregnancy rates (PRs) increased significantly with increasing endometrial thickness on the day of hCG administration and with increasing serum E2 level, but were not significantly related to age, BMI, or follicle numbers according to multiple logistic regression modeling. Peak endometrial thickness declined with age and increasing E2 levels. The BMI was associated with thicker endometrium, but it was also associated with lower peak E2 levels.
  
  
  CONCLUSIONS
  The impact of "endometrial factor" infertility may be underappreciated in IUI therapy. Targeted therapies to optimize the endometrium represent an important new area to improve in current fertility success rates.
authors.affiliation: Unit on Reproductive Regenerative Medicine, Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland 20892, USA. wolffe@mail.nih.gov
authors.forename: Erin Foran
authors.initials: EF
authors.lastname: Wolff
authors.forename: Nima
authors.initials: N
authors.lastname: Vahidi
authors.forename: Connie
authors.initials: C
authors.lastname: Alford
authors.forename: Kevin
authors.initials: K
authors.lastname: Richter
authors.forename: Eric
authors.initials: E
authors.lastname: Widra
mesh_terms: D004717:Endometrium / Q000166:cytology / Q000254:growth & development*; D005260:Female; D006801:Humans; D007247:Infertility, Female / Q000473:pathology / Q000628:therapy*; D007315:Insemination, Artificial / Q000379:methods*; D008297:Male; D011247:Pregnancy; D018873:Pregnancy Rate / Q000639:trends*; D012189:Retrospective Studies; D016896:Treatment Outcome