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Endometrial unresponsiveness: a novel approach to assessment and prognosis in in vitro fertilization cycles
1Miami IVF-ICSI Center, Shatby Hospital for Women, Alexandria University, Egypt.
Objective:
To categorize endometrial responsiveness to orally administered estriol in natural cycles of patients with thin endometrium. The value of endometrial responsiveness in predicting the outcome of subsequent IVF-ET cycles was evaluated.
Design:
Prospective clinical study.
Setting:
Miami IVF-ICSI Center, Alexandria, Egypt, a private center.
Patients:
Forty-two patients undergoing IVF-ET. All had endometrial thickness < or = 7 mm at the time of maximal follicular diameter in natural cycle.
Intervention:
Estriol was orally administered in subsequent unstimulated cycle. Patients were categorized into responsive and unresponsive groups (those with improved and unimproved endometrial thickness, respectively). Lastly, controlled ovarian hyperstimulation (COH) with or without estriol was started in the IVF-ET cycles.
Main Outcome Measures:
The endometrial thickness during COH with or without estriol, fertilization, pregnancy, and abortion rates.
Results:
The responsive group compared with the unresponsive group had a significantly higher rate of improved endometrial thickness, a similar number of oocytes retrieved, a similar fertilization rate, and a significantly higher pregnancy rate.
Conclusion:
Patients with endometrial unresponsiveness to estriol in their natural cycles rarely improve by COH and have a poor pregnancy rate in IVF cycles.