Hi doc,

on day 8 of my natural cycle, did ultrasound the endometrium is 7mm but not trilaminar. Estrogen is 65, follicle size is 11mm.
My uterus is arcuate and anteverted. Did 3d also, vascularity is zone2.

But i m concerne abt pattern which is not triple line.
Last cycle also triple line was not found, lining was 9.5.

At day 9 e2 is 143 pg/ml. Lh is 5
What do u think , lining like this (pattern) has a bad prognosis?

Hello Ria from India,

I have come to the conclusion that the doctors in India do not talk to their patients and explain as evidenced by the fact that I get lots of questions from India for things that they should answer.

The minimum lining width required for implantation is 7 mms and should be trilaminar.  If it is not trilaminar then the likelihood of implantation is decreased.  However, the estradiol level usually reaches about 150-250 pg/ml before ovulation occurs, which corresponds to an 18-20 mm follicle.  By then, the lining usually is 8-9 mms and trilaminar.  That usually will occur by CD#12-14.  You are still very early in your cycle.  Cycle success is determined by the factors collected by ultrasound and involves facts such as follicle size and endometrial lining.  There are no points within the cycle prior to the point of ovulation that are predictable of whether or not pregnancy will occur in that cycle, unless you just don't get to the point of ovulation!  I hope that answers your question.  The bottom line (as we like to say in the U.S.) is not to worry about the points leading to ovulation but only whether or not you reach the point of ovulation.  At that point, usually everything will be in its proper place to give you the chance of pregnancy, but remember, there are still 8 more steps the body has to go through for pregnancy to occur.

Good Luck,

Dr. Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program

Monterey, California, U.S.A.

for additional information check out my blog at check me out on twitter with me at @montereybayivf and facebook @montereybayivf.  I now provide personalized fee for service consultations/advice/direction via email and payable via Pay Pal.  If interested, contact me via my email at  This service will allow you to have your own personal on-demand infertility expert  


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Edward Joseph Ramirez, MD, FACOG


I am a specialist in infertility and advanced gynecological care. I can answer questions about infertility, gynecology related ills, menopause...virtually anything that affects women's health. PLEASE tell me where you are writing from as I am always interested.


I have been practicing as an Ob/Gyn and Infertility Specialist for over 23 years. Gynecology, advanced laparoscopic surgery, basic infertility, IUI's, IVF, reproductive surgery, and ovulation induction are all areas of my expertise. I am Board Certified. I have been doing In Vitro Fertilization in my clinic for 19 years.

American College of OB/GYN, American Board of Obstetrics and Gynecology, American Society of Reproductive Medicine, California Medical Association, American Association of Gynecologic Laparoscopists, Fellow of The American College of Obstetricians & Gynecologists

American Journal of Obstetrics and Gynecology, Wall Street Journal, Monterey Herald, SERMO, Women's Health and Fertility Blog

Medical Degree from Stanford University, Residency at Tripler Army Medical Center, Reproductive Training at Pacific Fertility Center, San Francisco

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