Sonographic assessment of endometrial pattern and thickness in patients treated with clomiphene citrate, human menopausal gonadotropins, and intrauterine insemination.

OBJECTIVE: To analyze the endometrium sonographically in patients undergoing controlled ovarian stimulation with clomiphene citrate (CC) in addition to menotropins to determine the significance of endometrial pattern and thickness on pregnancy rate (PR).
DESIGN: A prospective study analyzing patients receiving sequential CC and hMG followed by hCG and IUI. Patients who exhibited homogeneous endometrial patterns were compared with those who had trilaminar patterns visualized by transvaginal sonography at the end of the follicular phase. Endometrial thickness was emphasized in this group of patients.
SETTING: Tertiary infertility center. PATIENT(S): All patients receiving sequential CC and hMG therapy at a tertiary infertility center. INTERVENTION(S): All patients received individualized dosing of hMG after 5 days of CC. Transvaginal sonography was performed 15 hours before hCG administration. Intrauterine insemination was performed 36 hours after hCG injection. MAIN OUTCOME MEASURE(S): Occurrence of pregnancy as determined by serially rising beta-hCG titers and sonographic confirmation. RESULT(S): During the study period, 223 patients were analyzed. Fifty patients had a homogeneous endometrium, whereas 173 patients had a trilaminar pattern. In the homogeneous group, the PR was 8%, and in the trilaminar group it was 21%. There was no significant difference in age, parity, diagnosis, peak E2 level, and mature follicle number between the two groups. Although homogeneous patterns were associated with thinner endometrium, no difference in PRs could be discerned within the trilaminar group on the basis of endometrial thickness. CONCLUSION(S): In patients receiving sequential CC and hMG ovarian stimulation, a homogeneous endometrial pattern on the day of hCG administration predicts a significantly decreased PR compared with a trilaminar pattern.