Authors: Neumann Brooke, Check Jerome, Wilson Carrie.
Objectives: The presence of a triple line (TL) endometrial sonographic echo pattern has been associated with diminished fecundity. The purpose of the present study was to determine if advanced woman’s age increases the frequency of mid-luteal TL endometrial echo patterns. Furthermore, to see if the presence of this pattern, despite progesterone (P) supplementation, is associated with diminished live delivered pregnancy rates following frozen embryo transfer (FET).
Design: Retrospective Cohort Study.
Participants/Materials: Embryos derived from women aged <35 that were frozen and were subsequently transferred were used for this study.
Setting: University, IVF Center outside of the hospital-separate building.
Methods: All women were treated with the same graduated estrogen/progesterone regimen. Mid luteal phase sonograms were performed, and the type of endometrial echo patterns was determined Live delivered pregnancy rates (LDPRs) were determined according to three age groups at the time of transfer (<36, 36-39, and 40-42) and according to echo pattern.
Results: There was 2769 FETs in women <36 years old and 142 showed a midluteal TL pattern (5.4%). There were 907 FETs in women 36-39 and the TL pattern was found in 38 women (4.2%). There were 407 FETs in women aged 40-42 and 11 had the TL echo pattern (2.7%). The LDPR for women <36 was 34.7% (914/2627) for non-TL vs 37.3% (53/142) for TL pattern. In women 36-39, the LDPR for non-TL was 26.5% (230/669) vs 13.2% (5/38) for TL pattern. For women, aged 40-42, the LDPR was 12% (49/408) with non-TL and no live deliveries (0/11) with TL.
Limitations: Retrospective studies are not as credible for various reasons as prospective studies including fortuitous bias of the groups being compared. Frequently this disadvantage may be obviated by generally much larger number of subjects in retrospective studies as seen in the present study. The frequency of TL patterns were too low to determine if lower LDPR in women > 36 are real or fortuitous when TL pattern is seen.
Conclusions: Though the frequency of persistence of a TL pattern does not increase in frequency with advancing age, persistence of a TL pattern is uncommon. However, the LDPRs may be lower in women with advancing age if the pattern persists. This may be related to a subtle decrease in endometrial receptivity with advancing age only manifested in the extreme situation of persistence of a TL pattern. There is also the possibility that less quality embryos were the ones left for transfer in the women of advancing age. This possible confounding effect could have been negated by a prospective study, but as mentioned, a prospective study would suffer from lack of power.
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