The artificial cycle as an effective treatment of persistently retarded endometrium in the luteal phase

The objective of this study was to examine the results of two hormonal treatment modalities on subjects who had persistently abnormal endometrial development in the luteal phase. A prospective study design was used to investigate 14 women who had persistently retarded endometrium associated with infertility (n = 11) or recurrent miscarriage (n = 3). Treatment A consisted of progesterone supplementation in the form of i.m. progesterone at a daily dose of 25-50 mg starting on day luteinizing hormone (LH) + 1 for 14 days. Treatment B consisted of artificial cycles produced after down-regulation of the hypothalamic-pituitary-ovarian axis with Goserelin (3.6 mg s.c.) followed by the administration of a standard hormone replacement therapy. Endometrial biopsy was taken on day 19 of the artificial cycle or days LH + 5 to +7 in the progesterone supplementation cycle. A histological study was made of the endometrial specimens by standard dating criteria and morphometry. The artificial cycle resulted in normal development in all subjects (n = 11), whereas progesterone supplementation restored normal endometrial development in only seven of 11 (64%) subjects. We conclude that persistently retarded endometrium could be treated more effectively with the artificial cycle than with progesterone supplementation.