Published: 2020-06-25

Role of endometrial thickness in natural and stimulated cycles in infertility

Vandana Dhama, Kiran Kumari, Rachna Chaudhary, Shakun Singh


Background: The endometrium plays an important role in infertility. The growth of endometrium depends on serum oestradiol level and blood flow to the uterus. A thin endometrium is defined as a lining of less than 7 mm which is associated with infertility. The endometrium is best seen on Transvaginal scan (TVS). The purpose of this study was to evaluate the role of endometrial thickness and its outcome in natural and stimulated cycles in infertile women.

Methods: This prospective cohort study was conducted from June 2018 to May 2019 in LLRM Medical College Meerut, Uttar Pradesh, India. Total 150 infertile women of age less than 35 years presented with either primary or secondary infertility were enrolled. Each patient was undergoing transvaginal scan (TVS) to measure endometrial thickness follicular monitoring.

Results: The endometrial thickness and pregnancy rate was higher in letrozole induced group as compared to clomiphene with estradiol valerate and clomiphene with sildenafil citrate induced group.

Conclusions: Letrozole had better effect on endometrial thickness and pregnancy rate as compared to clomiphene citrate with estradiol valerate and clomiphene citrate with sildenafil citrate.


Clomiphine citrate, Endometrial thickness, Letrozole, Sildenafil citrate

Full Text:



Geyter De, Schmitter, De Gayter M, Nieschlage, Holzgreve W, Shnieder HP. Prospective evaluation of the ultrasound appearance of the Endometrial in a cohort of 10186 infertile women. Fertil Steril. 2000;73:106.

Hung E, Carina YN, Chan CW, Tang OS, Yeung WS, Ho PC. Factors affecting endometrial and subendometrial blood flow measured by three dimensional power doppler ultrasound during IVF treatment. Human Reprod. 2006;21(4):1062-9.

Gupta A, Desai A, Bhatt S. Imaging of the Endometrium: physiologic changes and diseases: women’s imaging. Radiolographics: a review publication of the Radiological Society of North America. Inc. 2017;37(7):2206-07.

Teramoto S, Osada H, Shozu M. Premature ruptured follicles often retain competent oocytes in infertile women. Sci Rep. 2019;9;1504.

Harira M. Use of Letrozole versus clomiphene citrate-estradiol for treating infertile women with unexplained infertility not responding well to clomiphene alone comparative study. Middle East Fertil Society J. 2018;4(23):384-7.

Mangal S, Mehirishi S. Compare the effect of vaginal sildenafil, estradiol valerate on endometrial thickness, blood flow and pregnancy rates in infertile women undergoing intrauterine insemination. Reprod. Contracept Obstet Gynecol. 2016;5(7);2274-7.

Budinetz TH, Griffin DW, Engmann LL, Benadiva CA, Nulsen JC, DiLuigi AJ. Ovulatory rate in subsequent clomiphene citrate (CC) cycle after ‘stair-step’(SS) clomiphene citrate protocol. Fertil Steril. 2012;98(3):S170.

Pritts EA. Letrozole for ovulation induction and controlled ovarian hyperstimulation. Curr Opin Obstet Gyneccol. 2010;22(4):289-94.

Founda UM, Sayed AM. Extended letrozole regimen versus clomiphene citrate for super ovulation in patients with unexplained infertility A randomized control trial. Reprod Biol Endocrinol. 2011;84:9.