Iranian Society of Gynecology Oncology

Document Type : Original Research Article


Department of Anatomy and Embryology, College of Medicine, Kerbala University, Kerbala, Iraq


Background & Objective: Infertility in women can be attributed to a wide variety of factors, including inherited and acquired abnormalities of the uterus. Ultrasonography is used for determining the thickness of the endometrium during various phases of the menstrual cycle. The purpose of this study is to determine the thickness of the endometrium in women who are unable to conceive using ultrasound imaging during the secretory phase.
Materials & Methods: A total of 134 adult females between the ages of 22 and 45 were examined by means of an endo-vaginal and transabdominal approach with EVN 4-9 MHZ and CA1-7AD probes, respectively, during the course of this research project, which took place in Imam Al-Hujjah Charitable Hospital, Karbala, Iraq, between February 2021 and April 2022.
Results: The findings showed that primary infertility accounted for 69.4% of cases, which was significantly higher than women with secondary infertility, which accounted for 30.6% of cases. There were 68.8% of women who presented with primary infertility who had endometrial thickness between 9-12 mm, and there were 31.1% of women who presented with secondary infertility who had this thickness. 65.8% of women who are experiencing primary infertility and 34.1% of women who are experiencing secondary infertility have an endometrial thickness of 14-18 mm. Our study showed that 40% of women who suffer from primary infertility and 60% of those who have secondary infertility have an endometrial thickness of 19-23 mm.
Conclusion: When it comes to diagnosing and treating infertility, ultrasound is a crucial tool for measuring the thickness of the endometrium in women.


Main Subjects

1. Johnson NP. Review of lipiodol treatment for infertility-an innovative treatment for endometriosis‐related infertility? Aust N Z J Obstet Gynaecol. 2014;54(1):9-12. [DOI:10.1111/ajo.12141] [PMID]
2. Daneii P, Sarmadi V, Mahmoudi N, Moaveni AK, Mohammad Alizadeh F, Neshat S, et al. Assessment of the Attributional Styles of High- and Low-grade Point Medical Students at Isfahan University of Medical Sciences: A Cross-sectional and Descriptive Study. J Health Sci Surveill Syst. 2022;10(2):229-32.
3. Zhang B, Cui Y, Wang M, Li J, Jin L, Wu D. In vitro fertilization (IVF) cumulative pregnancy rate prediction from basic patient characteristics. IEEE Access. 2019;7:130460-7. [DOI:10.1109/ACCESS.2019.2940588]
4. Nalaboff KM, Pellerito JS, Ben-Levi E. Imaging the endometrium: disease and normal variants. Radiographics. 2001;21(6):1409-24. [DOI:10.1148/radiographics.21.6.g01nv211409] [PMID]
5. Barker MA, Boehnlein LM, Kovacs P, Lindheim SR. Follicular and luteal phase endometrial thickness and echogenic pattern and pregnancy outcome in oocyte donation cycles. J Assist Reprod Genet. 2009;26(5):243-9. [DOI:10.1007/s10815-009-9312-z] [PMID] [PMCID]
6. Gonen Y, Casper RF, Jacobson W, Blankier J. Endometrial thickness and growth during ovarian stimulation: a possible predictor of implantation in in vitro fertilization. Fertil Steril. 1989;52(3):446-50. [DOI:10.1016/S0015-0282(16)60916-0] [PMID]
7. Hou Z, Zhang Q, Zhao J, Xu A, He A, Huang X, et al. Value of endometrial echo pattern transformation after hCG trigger in predicting IVF pregnancy outcome: a prospective cohort study. Reprod Biol Endocrinol. 2019;17(1):1-10. [DOI:10.1186/s12958-019-0516-5] [PMID] [PMCID]
8. Dietterich C, Check JH, Choe JK, Nazari A, Lurie D. Increased endometrial thickness on the day of human chorionic gonadotropin injection does not adversely affect pregnancy or implantation rates following in vitro fertilization-embryo transfer. Fertil Steril. 2002;77(4):781-6. [DOI:10.1016/S0015-0282(01)03276-9] [PMID]
9. Koninckx PR, Ussia A, Adamyan L, Gomel V, Martin DC. Peritoneal fluid progesterone and progesterone resistance in superficial endometriosis lesions. Hum Reprod. 2022;37(2):203-11. [DOI:10.1093/humrep/deab258] [PMID]
10. Pereira MM, Mainigi M, Strauss JF, III. Secretory products of the corpus luteum and preeclampsia. Hum Reprod Update. 2021;27(4):651-72. [DOI:10.1093/humupd/dmab003] [PMID] [PMCID]
11. Mascarenhas MN, Flaxman SR, Boerma T, Vanderpoel S, Stevens GA. National, regional, and global trends in infertility prevalence since 1990: a systematic analysis of 277 health surveys. PLoS Med. 2012;9(12):e1001356. [DOI:10.1371/journal.pmed.1001356] [PMID] [PMCID]
12. Practice Committee of the American Society for Reproductive Medicine. Definitions of infertility and recurrent pregnancy loss: a committee opinion. Fertil Steril. 2013;99(1):63. [DOI:10.1016/j.fertnstert.2012.09.023] [PMID]
13. Hajipour Khire Masjidi B, Bahmani S, Sharifi F, Peivandi M, Khosravani M, Mohammed A. CT-ML: Diagnosis of Breast Cancer Based on Ultrasound Images and Time-Dependent Feature Extraction Methods Using Contourlet Transformation and Machine Learning. Comput Intell Neurosci. 2022(24):1493847. [DOI:10.1155/2022/1493847] [PMID] [PMCID]
14. Tantengco OAG, de Castro Silva M, Velayo CL. The role of genital mycoplasma infection in female infertility: A systematic review and meta-analysis. Am J Reprod Immunol. 2021;85(6):e13390. [DOI:10.1111/aji.13390]
15. Hanson B, Johnstone E, Dorais J, Silver B, Peterson CM, Hotaling J. Female infertility, infertility-associated diagnoses, and comorbidities: a review. J Assist Reprod Genet. 2017;34(2):167-77. [DOI:10.1007/s10815-016-0836-8] [PMID] [PMCID]
16. Gallos ID, Khairy M, Chu J, Rajkhowa M, Tobias A, Campbell A, et al. Optimal endometrial thickness to maximize live births and minimize pregnancy losses: Analysis of 25,767 fresh embryo transfers. Reprod Biomed Online. 2018;37(5):542-8. [DOI:10.1016/j.rbmo.2018.08.025] [PMID]
17. Zahra H, Farooq SMY, tul Sughra SK, Asad N, Din HU, Zainab A, et al. Role Of Ultrasound In Assessment Of Endometrial Thickness In Secretory Phase Of Infertile Females: Role of Ultrasound in Assessment of Endometrial Thickness in Infertile Females. Pakistan Biomed j. 2021;4(2):245-50. [DOI:10.54393/pbmj.v4i2.109]
18. Rezaei Z, Adabi K, Sadjadi A. A Comparison of Endometrial Thickness and Pregnancy Outcomes in Two Methods of Intrauterine Injection and Subcutaneous Injection of GCSF in Infertile Women Candidates for IVF. J Obstet Gynecol Cancer Res. 2022;5(2):39-43. [DOI:10.30699/jogcr.5.2.39]
19. Bakhtiari M, Babaei T, Safarpour M, Esmaeili M, Esmaeili M, Asgari R. Investigating the Factors Affecting the ICSI (microinjection) Success in Infertile People Referred to an Infertility Treatment Center in Western Iran from 2011 to 2017. J Obstet Gynecol Cancer Res. 2022;5(3):115-25. [DOI:10.30699/jogcr.5.3.115]
20. Kovacs P, Matyas S, Boda K, Kaali SG. The effect of endometrial thickness on IVF/ICSI outcome. Hum Reprod. 2003;18(11):2337-41. [DOI:10.1093/humrep/deg461] [PMID]
21. Ebrahimi N, Adelian S, Shakerian S, Afshinpour M, Chaleshtori SR, Rostami N, et al. Crosstalk between ferroptosis and the epithelial-mesenchymal transition: Implications for inflammation and cancer therapy. Cytokine Growth Factor Rev. 2022;64:33-45. [DOI:10.1016/j.cytogfr.2022.01.006] [PMID]
22. Cheng F, Li T, Wang Q-L, Zhou H-L, Duan L, Cai X. Effects of hydrosalpinx on ultrasonographic parameters for endometrial receptivity during the window of implantation measured by power color Doppler ultrasound. Int J Clin Exp Med. 2015;8(4):6103.
23. Lessey BA, Young SL. What exactly is endometrial receptivity? Fertil Steril. 2019;111(4):611-7. [DOI:10.1016/j.fertnstert.2019.02.009] [PMID]
24. Zhong Y, Zeng F, Liu W, Ma J, Guan Y, Song Y. Acupuncture in improving endometrial receptivity: a systematic review and meta-analysis. BMC Complement Altern Med. 2019;19(1):1-19. [DOI:10.1186/s12906-019-2472-1] [PMID] [PMCID]
25. Zheng X, Liu L, Zhou H, Yang H, Wang F, Yang J. Endometrium receptivity and the dose-related effects of Acupuncture therapies in infertile women: a protocol for systematic review and meta analysis. medRxiv. 2021. [DOI:10.1101/2021.04.02.21254309]
26. Turkgeldi E, Hanege BY, Yildiz S, Keles I, Ata B. Subcutaneous versus vaginal progesterone for vitrified-warmed blastocyst transfer in artificial cycles. Reprod Biomed Online. 2020;41(2):248-53. [DOI:10.1016/j.rbmo.2020.04.007] [PMID]
27. Oluborode B, Burks H, Craig LB, Peck JD. Does the ultrasound appearance of the endometrium during treatment with assisted reproductive technologies influence pregnancy outcomes? Hum Fertil. 2022;25(1):166-75. [DOI:10.1080/14647273.2020.1757766] [PMID] [PMCID]
28. Alfer J, Happel L, Dittrich R, Beckmann MW, Hartmann A, Gaumann A, et al. Insufficient angiogenesis: cause of abnormally thin endometrium in subfertile patients? Geburtshilfe Frauenheilkd. 2017;77(07):756-64. [DOI:10.1055/s-0043-111899] [PMID] [PMCID]
29. Richter KS, Bugge KR, Bromer JG, Levy MJ. Relationship between endometrial thickness and embryo implantation, based on 1,294 cycles of in vitro fertilization with transfer of two blastocyst-stage embryos. Fertil Steril. 2007;87(1):53-9. [DOI:10.1016/j.fertnstert.2006.05.064] [PMID]
30. Santulli P, Lamau MC, Marcellin L, Gayet V, Marzouk P, Borghese B, et al. Endometriosis-related infertility: ovarian endometrioma per se is not associated with presentation for infertility. Hum Reprod. 2016;31(8):1765-75. [DOI:10.1093/humrep/dew093] [PMID]