Impact of ovulation and implantation timing on first-trimester crown-rump length and gestational age

A. A. Mahendru, A. Daemen, T. R. Everett, I. B. Wilkinson, C. M. McEniery, Y. Abdallah, D. Timmerman, T. Bourne, C. C. Lees*

*Corresponding author for this work

    Research output: Contribution to journalArticle

    21 Citations (Scopus)

    Abstract

    Objective To determine the impact of ovulation and implantation timing on first-trimester crown-rump length (CRL) and the derived gestational age (GA). Method One hundred and forty-three women who were trying to conceive were recruited prospectively. The timing of ovulation and implantation and the ovulation to implantation (O-I) interval were established in 101 pregnancies using home urinary tests for luteinizing hormone and human chorionic gonadotropin. In 71 ongoing pregnancies, GA determined by measurement of fetal CRL at 10-14 weeks' gestation was compared with GA based on ovulation and implantation day. First-trimester growth was determined by serial ultrasound scans at 6-7, 8-9 and 10-14 weeks. Results The median ovulation and implantation days were 16 and 27, respectively, with an O-I interval of 11 days. GA estimated from CRL at 10-14 weeks was on average 1.3 days greater than that derived from ovulation timing. CRL Z-score was inversely related to O-I interval (Ï = -0.431, P = 0.0009). There was no significant relationship between CRL growth rate and the difference between observed CRL and expected CRL based on GA from last menstrual period (Ï = 0.224, P = 0.08). Conclusions Early implantation leads to a larger CRL and late implantation to a smaller CRL at 10-14 weeks, independent of CRL growth rate. Implantation timing is a major determinant of fetal size at 10-14 weeks and largely explains the variation in estimates of GA in the first trimester derived from embryonic or fetal CRL.

    Original languageEnglish
    Pages (from-to)630-635
    Number of pages6
    JournalUltrasound in Obstetrics and Gynecology
    Volume40
    Issue number6
    DOIs
    Publication statusPublished - Dec 2012

    Keywords

    • CRL
    • dating
    • embryo
    • fetal growth
    • implantation
    • ovulation
    • ultrasound

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