Evaluation of

Endometrium in Infertile
Women
BAHGAT YASSIN MD,
CAIRO UNIVERSITY
Recall that: History
• Examination tools were speculum
and bimanual examinations.
• Ovarian stimulation cycles
monitored only by hormonal
assay of E2 levels.
• IVF was done using laparoscopic
retrieval of oocytes.
 Causes of Infertility
• Male factor (alone OR in conjuction) – 25 %

• Unexplained – 20%

• Female – 55%
• Ovulation dysfunction – 21%
• Tubal factors – 14 %
• Endometriosis – 6%
• Coital problems – 6%
• Uterine and Cervical factors – 3%
Jill Cunningham, JAAPA.
2017
 Causes of RPL
• Unknown – 41%
• Hormonal – 15-20%
• Autoimmune/ Blood clooting – 20%
• Anatomic (include endometrium) 15%
• Genetic – 5%

ASRM Committee opinion. RPL. 2012

ASSESSMENT OF THE
ENDOMETRIUM
I. ENDOMETRIUM THICKNESS.

II. ENDOMETRIAL PATTERN

III. ENDOMETRIAL REGULARITY

IV. ENDOMETRIAL MOTILITY

• The best sensitivity and specificity were obtained on the day
of HCG administration

Herve Dechaud, Reproductive BioMedicine Online. 2008

In fresh IVF-ET cycles, clinical pregnancy and live birth rates decreased (P < 0.0001)
and pregnancy loss rates increased (P = 0.01) with each millimeter decline in

endometrial thickness below 8 mm. 

In frozen–thaw ET cycles, clinical pregnancy (P = 0.007) and live birth rates decreased

(P = 0.002) with each millimeter decline in endometrial thickness below 7 mm

 ENDOMETRIAL
THICKNESS
• Highest probability of pregnancy occurring when endometrium
thickness is between 9-14 mm.

• Most of the studies are consistent regarding 6 mm as a lower

limit amenable for pregnancy.

• ONLY one case reports documenting pregnancy upon 4 mm

endometrium. Sundstrom P, Hum Reprod. 1998
 ENDOMETRIAL COMPACTING

Thinning, after progesterone starts may result in

optimal pregnancy rates
Jigal Haas, Fert and Steril
2019
• The endometrial volume was larger in the
cohort of pregnant patients.

• No differences were observed in

vascularization parameters in the
subendometrium and endometrium.
Richard B., Reproductive Sciences
2019
I. ENDOMETRIUM THICKNESS.

II. ENDOMETRIAL PATTERN

III. ENDOMETRIAL REGULARITY

IV. ENDOMETRIAL MOTILITY

Renato F., Fert & Steril 2000
 Endometrial Receptivity Grades
• Grade A or Receptive Triple
line appearance or
multilayered endometrium

Grade C: Non receptive

Homogenous appearance
I. ENDOMETRIUM THICKNESS.

II. ENDOMETRIAL PATTERN

III. ENDOMETRIAL REGULAROTY

IV. ENDOMETRIAL MOTILITY

ENDOMETRIAL REGULARITY
NIECH
Hysteroscopic view of uterine
cesarean scar defect

Thanks for Dr Alphy S. Puthiyidon

POLYP
Adhesions
 REGULAR ENDOMETRIUM

• Do not evaluate during

menstruation.

• Do not evaluate at
luteal phase.
I. ENDOMETRIUM THICKNESS.

II. ENDOMETRIAL PATTERN

III. ENDOMETRIAL REGULAROTY

IV. ENDOMETRIAL MOTILITY

 Motion Analysis
• Endometrial contractions may have a predictive effect on
the probability of pregnancy in IVF cycles.

• Uterine contractility at the time of blastocyst transfer was

lower and reached a nadir 7 days after hCG administration
in IVF cycles (blastocyst- progesterone).
Ari Kim. Int J Fertil Steril 2015
Cathy H S Chung. RBM 2017
HYSTEROSCOPIC
VIEW OF END.
MOTILITY

Thanks for Dr L. Alonzo

ULTRASOUND VIEW OF END.
MOTILITY
 Ultrasound based motion analysis images

3 contractions per 7 contractions per minute

minute
I. ENDOMETRIUM THICKNESS.

II. ENDOMETRIAL PATTERN

III. ENDOMETRIAL REGULAROTY

IV. ENDOMETRIAL MOTILITY

V. DO NOT MISS
 Peri-ovulatory Hydrometra
• 5% of cycles were compromised by the presence of
lumen fluid accumulation at some time during the
cycle.

• Fluid accumulations were found in almost 3 times as

many women with tubal factor infertility compared
with others.
Chan Lu., PL0S One 2013
The pregnancy rate
was markedly lower
than those who did
not exhibit
intraluminal fluid.

Nikita J.J Hum reprod Sci 2017

 HYDROSALPNIX
The presense of
hydrosalpnix increase
the risk of pregnancy
loss; and its treatment
nullify this effect
Hoda M Harb. RBMO. 2019
I. ENDOMETRIUM THICKNESS.

II. ENDOMETRIAL PATTERN

III. ENDOMETRIAL REGULAROTY

IV. ENDOMETRIAL MOTILITY

V. DO NOT MISS
 • The thinner the junctional zone at day of OPU,
the higher the implantation rate.
• The difference between JZ measured at the day
of down regulation and the day of OPU is a
predictor of the outcome of ICSI cycles.
A. Maged. European J of Obs & Gyn and Reproductive Biology 2017