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Endometriumdicke in der Sonographie – ein wichtiger Parameter der endometrialen Rezeptivität?

Endometrial thickness in sonography—an important parameter for endometrial receptiveness?

  • Leitthema
  • Published:
Gynäkologische Endokrinologie Aims and scope

Zusammenfassung

Regelhaft nutzen Reproduktionsmediziner die Sonographie, um die Endometrium(EM)-Dicke vor Embryotransfer (ET) zu beurteilen und diesen Parameter dann als prognostischen Faktor für das Implantationsverhalten zu verwenden. Allerdings sind das mütterliche Alter und die ovarielle Reaktion auf eine Stimulationstherapie mit rekombinantem follikelstimulierendem Hormon bei In-vitro-Fertilisation (IVF) und intrazytoplasmatischer Spermieninjektion (ICSI) prognostische Faktoren, die aber wiederum Einfluss auf die Entwicklung des Endometriums nehmen können. In einer Metaanalyse bot die EM-Dicke zwar eine begrenzte Möglichkeit, Frauen mit niedriger Chance auf Schwangerschaftseintritt herauszufiltern, allerdings sind Fälle unterhalb des Schwellenwerts der EM-Dicke von ≤7 mm selten. Schließlich ist die Assoziation zwischen einer niedrigen EM-Dicke und der Schwangerschaftswahrscheinlichkeit nicht stark, sodass ein Zyklusabbruch oder eine ET-Verschiebung nicht generell empfehlenswert ist. In einer Studie mit 11.000 IVF/ICSI-Zyklen wurde die EM-Dicke als unabhängiger Parameter zur Vorhersage von klinischer Schwangerschaft, Lebendgeburt, Spontanabort und Extrauteringravidität aufgezeigt. Allerdings ist auch hier die Effektstärke gering. Eine weitere Arbeit zeigt, dass zwar in der univariaten Analyse die Rate an fortlaufenden Schwangerschaften mit der Höhe des EM korreliert und dass die Chance, bei einem EM ≥ 9 mm zu konzipieren, statistisch größer ist als bei Werten von 3 bis 8 mm. Dennoch ist die Höhe des EM ein schwacher prognostischer Faktor, da der erwartete Anstieg der Lebendgeburtenrate bei Zunahme der EM-Dicke gering ist. Daher sollten bei einer IVF- oder ICSI-Therapie nicht allein aus der Höhe des EM weitere therapeutische Konsequenzen gezogen werden.

Abstract

Ultrasound is regularly used in reproductive medicine to assess endometrial thickness (EMT) before embryo transfer is carried out in order to use the EMT as a prognostic parameter for the likelihood of embryo implantation. Whether this really is reasonable is controversially discussed in the literature because factors, such as maternal age and ovarian response to ovarian stimulation by in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) cycles are important confounders of the thickness of the endometrium. In a meta-analysis the EMT provided a limited possibility to filter out women with a low chance of becoming pregnant; however, cases below the threshold of an EMT ≤7 mm are rare. Ultimately, the association between a low EMT and the probability of pregnancy is not strong, so that termination of the cycle or postponement of embryo transfer is not generally recommended. In a unicenter retrospective study with 11,000 IVF/ICSI cycles, it was shown that EMT is an independent prognostic factor for clinical pregnancy, live birth and for the risk for spontaneous abortion and extrauterine gravidity; however, the effect size is also small. Another larger retrospective analysis showed that in univariate analysis the rate of ongoing pregnancies correlates with the thickness of the endometrium and that the chance for conceiving is statistically better with an EMT ≥ 9 mm than with values between 3 mm and 8 mm. Nevertheless, the EMT is only a poor prognostic factor because the expected increase in live birth rates with increasing EMT is low. For this reason further therapeutic consequences should not be deduced from the height of the EMT for IVF or ICSI therapy.

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Abbreviations

ART:

Assistierte Reproduktive Therapie

BMI:

Body-Mass-Index

EM:

Endometrium

ET:

Embryotransfer

EUG:

Extrauteringravidität

FSH:

Follikelstimulierendes Hormon

ICSI:

Intrazytoplasmatischer Spermieninjektion

IVF:

In-vitro-Fertilisation

KI:

Konfidenzintervall

LGR:

Lebendgeburtenrate

OI:

Ovulationsinduktion

OR:

Odds Ratio

ROC-AUC:

Receiver-operating-characteristic-Kurve

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Authors and Affiliations

  1. Universitäres Kinderwunschzentrum Lübeck-Manhagen, Universitätsklinikum Schleswig-Holstein, Ratzeburger Allee 111–125, 23562, Lübeck, Deutschland

    T. Osterholz-Zaleski & G. Griesinger

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  1. T. Osterholz-Zaleski
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  2. G. Griesinger
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Correspondence to T. Osterholz-Zaleski.

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Interessenkonflikt

T. Osterholz-Zaleski und G. Griesinger geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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T. Strowitzki, Heidelberg

G. Griesinger, Lübeck

H. Kentenich, Berlin

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Osterholz-Zaleski, T., Griesinger, G. Endometriumdicke in der Sonographie – ein wichtiger Parameter der endometrialen Rezeptivität?. Gynäkologische Endokrinologie 16, 147–152 (2018). https://doi.org/10.1007/s10304-018-0204-0

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  • DOI: https://doi.org/10.1007/s10304-018-0204-0

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