Influences on endometrial development during intrauterine insemination: clinical experience of 2,929 patients with unexplained infertility
2013
Wolff, Erin Foran | Vahidi, Nima | Alford, Connie | Richter, Kevin | Widra, Eric
OBJECTIVE: To characterize relationships associated with adverse endometrial development in patients undergoing IUI for unexplained infertility. DESIGN: A retrospective review of 2,929 patients from 2004–2011. SETTING: Large metropolitan infertility practice. PATIENT(S): Patients with unexplained infertility undergoing first IUI cycle at age less than 43 years, with a total motile sperm count ≥8 million. INTERVENTION(S): Clomiphene citrate (CC) with FSH stimulation followed by IUI. MAIN OUTCOME MEASURE(S): 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. RESULT(S): 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. CONCLUSION(S): 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.
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