Artificial insemination. Role of endometrial thickness and pattern, of vascular impedance of the spiral and uterine arteries, and of the dominant follicle.

OBJECTIVE

To assess the roles of endometrial thickness and pattern, as well as vascular impedance of the spiral and uterine arteries and dominant follicle in predicting the pregnancy rate in women receiving controlled ovarian hyperstimulation (COH) following by intrauterine insemination (IUI).

STUDY

DESIGN

All idiopathically infertile couples who accepted COH + IUI for the first time were prospectively included. The COH agents included clomiphene citrate and human menopausal gonadotropins. Endometrial thickness and pattern (trilaminar, nontrilaminar) and vascular impedance (pulsatility index [PI], resistance index [RI]) of the spiral and uterine arteries and ovarian dominant follicle were measured on the day of IUI. Analyses were made of the influences on pregnancy outcomes by endometrial thickness and pattern as well as Doppler surveys of the spiral and uterine arteries and dominant follicle.

RESULTS

A total of 110 couples with 110 cycles were enrolled, and there were 16 resulting pregnancy cycles. Trilaminar endometrium appeared in 87.5% and 57.4% of pregnant and nonpregnant women (P = .022), respectively. The pregnancy rates in trilaminar and nontrilaminar groups were 17.9% and 6.3%, respectively (P = .022). Endometrial thickness and PI/RI values for the spiral artery and uterine arteries and dominant follicle in pregnant women (12.1 +/- 2.6; 1.28 +/- 0.33/0.68 +/- 0.12; 2.67 +/- 0.51/0.72 +/- 0.32; 0.71 +/- 0.19/0.54 +/- 0.06 mm, respectively) were not statistically different from those for nonpregnant women (11.0 +/- 2.9; 1.46 +/- 0.49/0.71 +/- 0.21; 2.81 +/- 0.65/0.88 +/- 0.34; 0.74 +/- 0.24/0.55 +/- 0.09, respectively).

CONCLUSION

A trilaminar endometrium on the day of IUI provides a favorable prediction of pregnancy. Endometrial thickness and Doppler surveys of the spiral and uterine arteries and dominant follicle do not have useful predictive value in COH + IUI.