Sonographic assessment of late proliferative phase endometrium during ovulation induction.

Late proliferative phase endometrium was assessed sonographically in 400 patients undergoing ovulation monitoring or stimulation. Endometrial evaluation was classified in relation to its widest diameter (quantity) and by the presence or absence of a double-layered (outer echogenic/inner hypoechoic) pattern (quality). No patient conceived if the endometrium was totally echogenic and less than 8 mm in diameter. All patients who conceived had an endometrium that was double-layered or greater than 9 mm in diameter. Positive, double-layered patterns correlated with correction of hormonal aberrations such as hypoestrogenism, hyperprolactinemia or hyperandrogenism. Such a positive pattern was also accomplished after discontinuation of clomiphene citrate in certain low-body weight/low-body fat women and administration of human menopausal gonadotropins to those patients. Application of the principles described to ensure the development of an adequate, double-layered (follicular phase) endometrium at midcycle were found to coincide with a higher incidence of pregnancy and viable gestation.