Critical ultrasound values for IVF cycles 试管周期超声检查临界值

分类:医学文献 40 0

Endometrial pattern


The importance of endometrial pattern and thickness to successful outcome in IVF and gamete intrafallopian transfer was first described by Smith et al. (1). They found that implantation did not occur, or occurred less often, if the endometrium lacked a triple-line pattern on the day of, or one day before, ovum retrieval in IVF cycles. This finding was later confirmed by others (2, 3). A triple-line endometrial pattern on the day of hCG administration in IVF cycles is relate to serum estradiol level, the number of mature oocytes, and the number of top-quality embryos and is unrelated to serum progesterone levels (3).


Endometrial thickness


Pregnancy does not occur in IVF cycles, presumably because of failure of embryos to implant, if the endometrium is too thin on the day of hCG administration according to the majority of studies. However, other studies have reported no relationship between thickness and pregnancy in IVF cycles. Many of the studies that failed to find a relationship between thickness and outcome compared mean thickness in conception and non-conception cycles, while most studies that found a relationship reported critical or “cut-off” values below which no pregnancies occurred. In most studies, the critical thickness value is reported as 6mm, but the range is from 4mm (4) to 6mm (5). One reason for these differences is that endometrial thickness can change, either increasing or decreasing, between the day hCG is administered and the day implantation is presumed to occur, a difference of 8-9 days. Importantly, in all studies of oocyte donation, endometrial thickness on the day of embryo transfer has been found to be critical for implantation.


As is true for ovarian induction and intrauterine insemination, optimal ART pregnancy and birth rates occur when endometrial thickness on the day of hCG administration is equal to or greater than 9mm (3) or 10mm (6). Endometrium that is too thick, 14mm or greater on the day of hCG administration, may reduce the chance of a clinical pregnancy (3). Increased susceptibility to injury at the time of embryo transfer has been proposed as the reason for decreased clinical pregnancies by Dickey et al., who found that biochemical pregnancies were more frequent in IVF cycles when endometrial thickness was less than 9mm or greater than 13mm (3). No relationship between endometrial thickness on the day of hCG and biochemical pregnancy was observed in IVF cycles in another study (7). An excessively thick endometrium may have its origins in the previous cycles. It is common practice not to start ovulation induction in ART and intrauterine insemination cycles following menstruation when endometrial thickness is greater than 6mm.

与卵巢诱导排卵和宫腔内人工授精类似,当内膜厚度在hCG给药当天大于或等于9mm (3)或者10mm(6)时,辅助生殖周期会出现最优的妊娠率和出生率。内膜过厚,厚度大于或等于14mm时可能会降低临床妊娠率(3)。Dickey等人提出在胚胎移植时内膜对损伤的敏感性增加是临床妊娠率降低的原因,他们发现当内膜厚度小于9mm或者大于13mm时,试管周期更容易出现生化妊娠(3)。另一项研究发现试管周期中hCG给药当天内膜厚度与生化妊娠没有关系(7)。过厚的子宫内膜可能来源于上一次周期。当子宫内膜厚度大于6mm时,通常做法是不开始卵巢诱导排卵或宫腔内人工授精周期。

Other ultrasound findings


Implantation rarely occurs when endometrial fluid is present on ultrasound on the day of embryo transfer, even when the fluid is aspirated (8). Endometrial polyps less than 2cm do not decrease pregnancy rates, but there is a trend toward increased pregnancy loss (9).




1. Smith B, Porter R, Ahuja K, Craft I. Ultrasonic assessment of endometrial changes in stimulated cycles in an in vitro fertilization and embryo transfer program. J IVF-ET 1984; 1:233-8.

2. Gonen Y, Casper RF, Jacobson W, Blankier J. Endometrial thickness and growth during ovarian stimulation: a possible predictor of implantation in in vitro fertilization. Fertil Steril 1989; 52: 446-50.

3. Dickey RP, Olar TT, Curole DN, Taylor SN, Rye PH. Endometrial pattern and thickness associated with pregnancy outcome after assisted reproduction technologies. Hum Reprod 1992; 7: 418-21.

4. Sundstrom P. Establishment of a successful pregnancy following in-vitro fertilization with an endometrial thickness of no more than 4mm. Hum Reprod 1998; 13: 1550-2.

5. Shoham Z, De Carlo C, Patel A, Conway GS, Jacobs HS. Is it possible to run a successful ovulation induction program based solely on ultrasound monitoring? The importance of endometrial measurements. Fertil Steril 1991; 56: 836-41.

6. Check JH, Nowroozi K, Choe J, Lurie D, Dietterich C. The effect of endometrial thickness and echo pattern on in vitro fertilization outcome in donor oocyte-embryo transfer cycle. Fertil Steril 1993; 59: 72-5.

7. Krampl E, Feichtinger W. Endometrial thickness and echo patterns. Hum Reprod 1993; 8: 1339.

8. Mansour RT, Aboulghar MA, Serour GI, Riad R. Fluid accumulation o the uterine cavity before transfer: a possible hindrance for implantation. J IVF-ET 1991; 8: 157-9.

9. Lass A, Williams G, Abusheikha N, Brinsden P. The effect of endometrial polyps on outcomes of in vitro fertilization cycles. J Assist Reprod Genet 1999; 16: 410-15.

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