Purpose: To evaluate the effect of extended estrogen administration for women with thin endometrium in frozen-thawed in-vitro fertilization (IVF) programs.
Methods: Thirty-six women undergoing IVF program had thin endometrium (<8 mm). Among them, 23 received fresh embryo transfer (control group), but 13 canceled embryo transfer and underwent frozen-thawed embryo transfer in the subsequent cycle after extended administration of exogenous estrogen (study group).
Results: In the study group, the mean endometrial thickness increased significantly from 6.7 mm in controlled ovarian hyperstimulation cycles to 8.6 mm after an extended estrogen therapy for 14 to 82 days (P=0.031). Their pregnancy rate was significantly higher than that in the control group (38.5% vs. 4.3%, P=0.016). Among 5 women achieving pregnancies in the study group, one was complicated with placenta accreta, and the other 4 had uneventful pregnancies.
Conclusions: Extended estrogen administration followed by frozen-thawed IVF programs is beneficial for women with thin endometrium. However, the risk of abnormal placentation and peripartal complication should be kept in mind.
Extended estrogen administration Frozen-thawed embryo transfer In-vitro fertilization Thin endometrium
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Dickey RP, Olar TT, Curole DN, Taylor SN, Rye PH. Endometrial pattern and thickness associated with pregnancy outcome after assisted reproduction technologies. Hum Reprod 1992; 7:418–21PubMedGoogle Scholar
Steer CV, Campbell S, Tan SL, Crayford T, Mills C, Mason BA, Collins WP. The use of transvaginal color flow imaging after in vitro fertilization to identify optimum uterine conditions before embryo transfer. Fertil Steril 1992;57:372–6PubMedGoogle Scholar
Yang JH, Wu MY, Chen CD, Jiang MC, Ho HN, Yang YS. Association of endometrial blood flow as determined by a modified colour Doppler technique with subsequent outcome of in-vitro fertilization. Hum Reprod 1999;14:1606–10PubMedCrossRefGoogle Scholar
Check JH, Nowroozi K, Choe J, Dietterich C. Influence of endometrial thickness and echo patterns on pregnancy rates during in vitro fertilization. Fertil Steril 1991;56:1173–5PubMedGoogle Scholar
Gonen Y, Casper RF, Jacobson W, Blankier J. Endometrial thickness and growth during ovarian stimulation: a possible predictor of implantation in in vitro fertilization. Fertil Steril 1989;52:446–50PubMedGoogle Scholar
Hock DL, Bohrer MK, Ananth CV, Kemmann E. Sonographic assessment of endometrial pattern and thickness in patients treated with clomiphene citrate, human menopausal gonadotropins, and intrauterine insemination. Fertil Steril 1997;68:242–5PubMedCrossRefGoogle Scholar
Abdalla HI, Brooks AA, Johnson MR, Kirkland A, Thomas A, Studd JW. Endometrial thickness: a predictor of implantation in ovum recipients? Hum Reprod 1994;9:363–5PubMedGoogle Scholar
Basir GS, O WS, So WW, Ng EH, Ho PC. Evaluation of cycle-to-cycle variation of endometrial responsiveness using transvaginal sonography in women undergoing assisted reproduction. Ultrasound Obstet Gynecol 2002;19:484–9PubMedCrossRefGoogle Scholar
Isaacs JD, Jr., Wells CS, Williams DB, Odem RR, Gast MJ, Strickler RC. Endometrial thickness is a valid monitoring parameter in cycles of ovulation induction with menotropins alone. Fertil Steril 1996;65:262–6PubMedGoogle Scholar
Ohno Y, Fujimoto Y. Endometrial oestrogen and progesterone receptors and their relationship to sonographic appearance of the endometrium. Hum Reprod Update 1998;4:560–4PubMedCrossRefGoogle Scholar
Queenan JT, Jr., Ramey JW, Seltman HJ, Eure L, Veeck LL, Muasher SJ. Transfer of cryopreserved-thawed pre-embryos in a cycle using exogenous steroids without prior gonadotrophin-releasing hormone agonist suppression yields favourable pregnancy results. Hum Reprod 1997;12:1176–80PubMedCrossRefGoogle Scholar
Younis JS, Simon A, Laufer N. Endometrial preparation: lessons from oocyte donation. Fertil Steril 1996;66:873–84PubMedGoogle Scholar
Weckstein LN, Jacobson A, Galen D, Hampton K, Hammel J. Low-dose aspirin for oocyte donation recipients with a thin endometrium: prospective, randomized study. Fertil Steril 1997;68:927–30PubMedCrossRefGoogle Scholar
Sher G, Fisch JD. Vaginal sildenafil (Viagra): a preliminary report of a novel method to improve uterine artery blood flow and endometrial development in patients undergoing IVF. Hum Reprod 2000;15:806–9PubMedCrossRefGoogle Scholar
Sher G, Fisch JD. Effect of vaginal sildenafil on the outcome of in vitro fertilization (IVF) after multiple IVF failures attributed to poor endometrial development. Fertil Steril 2002;78:1073–6PubMedCrossRefGoogle Scholar
Ledee-Bataille N, Olivennes F, Lefaix JL, Chaouat G, Frydman R, Delanian S. Combined treatment by pentoxifylline and tocopherol for recipient women with a thin endometrium enrolled in an oocyte donation programme. Hum Reprod 2002;17:1249–53PubMedCrossRefGoogle Scholar
Michalas S, Loutradis D, Drakakis P, Kallianidis K, Milingos S, Deligeoroglou E, Aravantinos D. A flexible protocol for the induction of recipient endometrial cycles in an oocyte donation programme. Hum Reprod 1996;11:1063–6PubMedGoogle Scholar
Remohi J, Gutierrez A, Cano F, Ruiz A, Simon C, Pellicer A. Long oestradiol replacement in an oocyte donation programme. Hum Reprod 1995;10:1387–91PubMedGoogle Scholar
Younis JS, Mordel N, Ligovetzky G, Lewin A, Schenker JG, Laufer N. The effect of a prolonged artificial follicular phase on endometrial development in an oocyte donation program. J In Vitro Fert Embryo Transf 1991;8:84–8PubMedCrossRefGoogle Scholar
Ho HN, Chen HF, Yang YS, Lin HR, Melinda S, Lien YR, Liu CH, Hwang JL, Hsieh CY, Lee TY. Pregnancy after transfer of frozen-thawed human embryos. J Formos Med Assoc 1992;91:708–11PubMedGoogle Scholar
Kurman RJ, Felix JC, Archer DF, Nanavati N, Arce J, Moyer DL. Norethindrone acetate and estradiol-induced endometrial hyperplasia. Obstet Gynecol 2000;96:373–9PubMedCrossRefGoogle Scholar
Remohi J, Ardiles G, Garcia-Velasco JA, Gaitan P, Simon C, Pellicer A. Endometrial thickness and serum oestradiol concentrations as predictors of outcome in oocyte donation. Hum Reprod 1997;12:2271–6PubMedCrossRefGoogle Scholar
Queenan JT, Jr., Veeck LL, Seltman HJ, Muasher SJ. Transfer of cryopreserved-thawed pre-embryos in a natural cycle or a programmed cycle with exogenous hormonal replacement yields similar pregnancy results. Fertil Steril 1994;62:545–50PubMedGoogle Scholar
Meresman GF, Bilotas M, Buquet RA, Baranao RI, Sueldo C, Tesone M. Gonadotropin-releasing hormone agonist induces apoptosis and reduces cell proliferation in eutopic endometrial cultures from women with endometriosis. Fertil Steril 2003;80(Suppl 2):702–7PubMedCrossRefGoogle Scholar
Meresman GF, Bilotas MA, Lombardi E, Tesone M, Sueldo C, Baranao RI. Effect of GnRH analogues on apoptosis and release of interleukin-1beta and vascular endothelial growth factor in endometrial cell cultures from patients with endometriosis. Hum Reprod 2003;18:1767–71PubMedCrossRefGoogle Scholar
Imai A, Takagi A, Tamaya T. Gonadotropin-releasing hormone analog repairs reduced endometrial cell apoptosis in endometriosis in vitro. Am J Obstet Gynecol 2000;182:1142–6PubMedCrossRefGoogle Scholar
Dada T, Salha O, Allgar V, Sharma V. Utero-ovarian blood flow characteristics of pituitary desensitization. Hum Reprod 2001;16:1663–70PubMedCrossRefGoogle Scholar
Simon A, Hurwitz A, Zentner BS, Bdolah Y, Laufer N. Transfer of frozen-thawed embryos in artificially prepared cycles with and without prior gonadotrophin-releasing hormone agonist suppression: a prospective randomized study. Hum Reprod 1998;13:2712–17PubMedGoogle Scholar
Jewelewicz R, Khalaf S, Neuwirth RS, Vande Wiele RL. Obstetric complications after treatment of intrauterine synechiae (Asherman’s syndrome). Obstet Gynecol 1976;47:701–5PubMedGoogle Scholar
Capella-Allouc S, Morsad F, Rongieres-Bertrand C, Taylor S, Fernandez H. Hysteroscopic treatment of severe Asherman’s syndrome and subsequent fertility. Hum Reprod 1999;14:1230–33PubMedCrossRefGoogle Scholar