{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,2]],"date-time":"2026-11-02T20:18:46Z","timestamp":1793650726992,"version":"4.5.1"},"reference-count":85,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2025,8,4]],"date-time":"2025-08-04T00:00:00Z","timestamp":1754265600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2025,8,4]],"date-time":"2025-08-04T00:00:00Z","timestamp":1754265600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet & Gyne"],"published-print":{"date-parts":[[2025,9]]},"abstract":"ABSTRACT<\/jats:title>\n \n Objective<\/jats:title>\n To evaluate the impact of endometrial thickness on the reproductive outcomes of embryo transfer (ET) treatments using both cut\u2010off\u2010based meta\u2010analysis and meta\u2010analysis of proportions.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n This was a systematic review and meta\u2010analysis of comparative studies (randomized controlled trials, cohort studies, case\u2013control studies) and descriptive studies (cross\u2010sectional studies, case series) published in English, French, German, Italian or Spanish and analyzing the impact of endometrial thickness on the rates of embryo implantation, clinical pregnancy, live birth, miscarriage and\/or ectopic pregnancy in fresh and\/or frozen\u2013thawed ET cycles. Live\u2010birth rate was defined as the primary outcome. The literature search was conducted in MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials,\n ClinicalTrials.gov<\/jats:ext-link>\n , Web of Science and \u00cdnDICEs\u2010CSIC, from inception of each database until 1 September 2024. The risk of bias was assessed using the Newcastle\u2013Ottawa scale for analytical studies and the Joanna Briggs Institute tool for descriptive studies. Pooled effects were estimated as odds ratios (OR) or risk differences obtained from a random\u2010effects model, with 95% CIs. Linear meta\u2010regression was used to assess the relationship between risk difference and endometrial thickness cut\u2010off. Meta\u2010analysis of proportions was performed as a secondary analysis, comparing outcome rates between 2\u2010mm intervals of endometrial thickness and a reference category (\u2265\u20096 to <\u20098\u2009mm).\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n A total of 67 studies were included, of which 22 were cohort studies and 45 were descriptive. In fresh ET cycles, the live\u2010birth rate was higher in patients with a thicker endometrium across cut\u2010offs from \u2265\u20095\u2009mm (OR, 5.66 (95%\u2009CI, 1.10\u201328.98)) to \u2265\u200915\u2009mm (OR, 1.49 (95%\u2009CI, 1.26\u20131.77)). Effect size decreased linearly as the cut\u2010off increased (\n P<\/jats:italic>\n \u2009<\u20090.0001;\n R<\/jats:italic>\n 2<\/jats:sup>\n \u2009=\u200961.5%). Meta\u2010analysis of proportions found significant differences in live\u2010birth rate when the reference category (\u2265\u20096 to <\u20098\u2009mm) (0.26 (95%\u2009CI, 0.22\u20130.30);\n I<\/jats:italic>\n 2<\/jats:sup>\n \u2009=\u200994.3%) was compared to the groups with endometrial thickness of \u2265\u20094 to <\u20096\u2009mm (0.17 (95%\u2009CI, 0.14\u20130.20);\n I<\/jats:italic>\n 2<\/jats:sup>\n \u2009=\u20090%), \u2265\u200910 to <\u200912\u2009mm (0.35 (95%\u2009CI, 0.28\u20130.42);\n I<\/jats:italic>\n 2<\/jats:sup>\n \u2009=\u200999.2%), \u2265\u200912 to <\u200914\u2009mm (0.43 (95%\u2009CI, 0.33\u20130.53);\n I<\/jats:italic>\n 2<\/jats:sup>\n \u2009=\u200999.5%) and \u2265\u200914 to <\u200916\u2009mm (0.39 (95%\u2009CI, 0.27\u20130.51);\n I<\/jats:italic>\n 2<\/jats:sup>\n \u2009=\u200999.2%). In frozen\u2013thawed ET cycles, thicker endometrium was associated with a higher live\u2010birth rate for cut\u2010offs between \u2265\u20095\u2009mm (OR, 2.65 (95%\u2009CI, 1.23\u20135.72);\n I<\/jats:italic>\n 2<\/jats:sup>\n \u2009=\u20090%) and \u2265\u20098\u2009mm (OR, 1.17 (95%\u2009CI, 1.10\u20131.24);\n I<\/jats:italic>\n 2<\/jats:sup>\n \u2009=\u200913%). A linear relationship between endometrial thickness and effect size was observed for this analysis (\n P<\/jats:italic>\n \u2009<\u20090.0001;\n R<\/jats:italic>\n 2<\/jats:sup>\n \u2009=\u200973.8%). In fresh ET cycles, endometrial thickness was correlated positively with the rates of clinical pregnancy and embryo implantation, inversely with miscarriage rate and showed no correlation with ectopic pregnancy. In frozen\u2013thawed ET cycles, thicker endometrium was correlated positively with the rate of clinical pregnancy and inversely with that of miscarriage. Evidence quality was rated as very low in 70% of assessments because of bias and inconsistency.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n Endometrial thickness is associated with reproductive outcomes, but demonstrates a gradient of effectiveness as a prognostic indicator, rather than offering a critical threshold below which ET should be avoided. ET scheduling should consider endometrial thickness alongside other prognostic factors. \u00a9 2025 The Author(s).\n Ultrasound in Obstetrics & Gynecology<\/jats:italic>\n published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/uog.29270","type":"journal-article","created":{"date-parts":[[2025,8,4]],"date-time":"2025-08-04T12:34:08Z","timestamp":1754310848000},"page":"271-281","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Impact of endometrial thickness on reproductive outcome in fresh and frozen\u2013thawed embryo transfer: systematic review and meta\u2010analysis"],"prefix":"10.1002","volume":"66","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5320-3739","authenticated-orcid":false,"given":"F.","family":"P\u00e9rez\u2010Mil\u00e1n","sequence":"first","affiliation":[{"name":"Reproductive Medicine Unit, Obstetrics and Gynecology Department Hospital General Universitario Gregorio Mara\u00f1\u00f3n Madrid Spain"},{"name":"Gregorio Mara\u00f1\u00f3n Institute for Health Research Madrid Spain"},{"name":"Universidad Complutense Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Caballero\u2010Campo","sequence":"additional","affiliation":[{"name":"Reproductive Medicine Unit, Obstetrics and Gynecology Department Hospital General Universitario Gregorio Mara\u00f1\u00f3n Madrid Spain"},{"name":"Gregorio Mara\u00f1\u00f3n Institute for Health Research Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Carrera\u2010Roig","sequence":"additional","affiliation":[{"name":"Universidad Complutense Madrid Spain"},{"name":"Reproductive Medicine Unit, Obstetrics and Gynecology Department Hospital Universitario Doce de Octubre Madrid Spain"},{"name":"Reproductive Medicine Unit, Hospital Universitario HLA Moncloa, Universidad Europea Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. 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