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. 2025 May 13:17:1363-1374.
doi: 10.2147/IJWH.S521115. eCollection 2025.

Endometrial Thickness Change in Response to Progesterone is Associated with Ongoing Pregnancy Rate in Women with Treated Intrauterine Adhesion - A Prospective Cohort Study

Zhaojuan Hou  1   2 , Bin Xu  1   2 , Jing Zhao  1   2 , Qiong Zhang  1   2 , Tianli Yang  1   2 , Fen Tian  1   2 , Baisheng Wang  3 , Yanping Li  1   2
Affiliations

Endometrial Thickness Change in Response to Progesterone is Associated with Ongoing Pregnancy Rate in Women with Treated Intrauterine Adhesion - A Prospective Cohort Study

Zhaojuan Hou et al. Int J Womens Health. .

Abstract

Objective: This study aimed to investigate whether endometrial thickness (EmT) change prognosticates the ongoing pregnancy rate (OPR) in hormonally prepared frozen-thawed embryo transfers (FETs) in women with treated intrauterine adhesion (IUA).

Methods: We prospectively examined 261 FET cycles in women with IUA. Ultimately, 156 patients were included in the final analysis. The primary outcome was OPR. The association between the EmT change ratio and OPR, as well as the relationship between the EmT change and serum hormone concentration, was analyzed.

Results: The intraclass correlation coefficient for repeated EmT measurements was 0.944 (95% CI: 0.933-0.954, P < 0.001). Subdividing by the expansion cutoff from 5% to 15%, the 10% expansion group had the highest OPR with optimal sensitivity and specificity. Regarding the baseline characteristics, there were no statistically significant differences between the two groups. Nevertheless, the OPR increased significantly in cycles with endometrial expansion ≥ 10% compared to those with no expansion (55.3% vs 26.3%, P=0.001). The difference was still significant after adjustment between the two groups (adjusted OR, 3.74; 95% CI 1.68-8.34, P=0.001). No correlation was found between the EmT change and serum hormone concentrations.

Conclusion: Endometrial expansion was significantly correlated with higher OPR in women with treated IUA in the hormonal protocol for FET.

Keywords: endometrial thickness; frozen embryo transfer; intrauterine adhesion; pregnancy outcomes; progesterone.

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Conflict of interest statement

The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Bland-Altman plots for intraobserver agreement of measurement of endometrial thickness by ultrasound. Horizontal lines show estimates of lower and upper limits of agreement.
Figure 2
Figure 2
Flowchart of patients.
Figure 3
Figure 3
Ultrasound images of the endometrium. Endometrial expansion measured on the progesterone administration day (A) and on the embryo transfer day (B) from the same cycle in one patient. Endometrial compaction measured on the progesterone administration day (C) and on the embryo transfer day (D) from the same cycle in another patient. All images were taken by transvaginal grayscale ultrasound on a sagittal plane.
Figure 4
Figure 4
The endometrial thickness changes were divided into tertiles. Tertile 3 represents the most endometrial expansion and tertile 1 represents the most endometrial compaction.
Figure 5
Figure 5
Receiver operating characteristic (ROC) curve for endometrial expansion and ongoing pregnancy rate. Vertical lines from left to right represent 15%, 10%, and 5% expansion. The area under the curve is 0.618, 95% confidence interval 0.522–0.714; P=0.016.
Figure 6
Figure 6
Risk factors for ongoing pregnancy of IUA patients in hormonally prepared frozen-thawed embryo transfer cycles. aon the progesterone initiation day. bon the embryo transfer day.
See this image and copyright information in PMC

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