Endometrial structural pathological changes in infertile patients is above 40%; while having «thin lining» implantation process is restricted, which explains high rates of implantation failures in IVF programs. Hormonal therapy is an effective way to increase endometrial thickness, but in spite of the diversity of estrogen dosage forms the consensus therapeutic approach has not been developed yet.
OBJECTIVE
To compare: 1) endometrial characteristics; 2) duration of treatment, total dosage and unfavorable side effects; 3) results of frozen-thawed embryo transfer (ET); 4) to find out independent predictors of successful ET after the management of «thin lining» with different estrogen dosage forms.
MATERIALS AND METHODS
Comparative retrospective multicenter randomized research (n=420). 1st group (n=225) was treated with estradiol hemihydrate, transdermal applications (Divigel, Orion Corporation, Finland); 2nd group (n=195) — estradiol valerate, oral form (Proginova, Delpharm Lille, France). Inclusion criteria: age ≤40, endometrial thickness <8 mm during luteal phase, absence of severe uterine disease, severe extragenital diseases, contraindications to estrogen treatment, low risk of thrombosis, ET ≤2 frozen-thawed good-quality embryos.
RESULTS
Increase of endometrial growth in groups was comparable: 9.8 (2.7) mm and 9.7 (2.5) mm respectively (p=0.524); adequate peristalsis was seen significantly more often in the 1st group (177/225 (76.0%) v.s. 116/195 (59.5%); p=0.039), equally to adequate endometrial perfusion (220/225 (97.8%) v.s. 165/195 (84.6%); p=0.001). Mean duration of estrogen treatment before ET was significantly shorter in the 1st group (14.0 (4.1) v.s. 14.7 (4.7) days; p=0.043), the same as total estrogen dosage (41.3 (26.8) mg v.s. 69.4 (36.3) mg; p=0.0001). Comparable amount of the recruited remarked unfavorable moderate side effects (12/225 (5.3%) and 14/195 (7.2%); p=0.453). Clinical pregnancy rates were comparable (108/225 (48.0%) and 93/195 (48.7%); p=0.079), equally to «take baby home» index (71/225 (31.6%) and 61/195 (31.3%); p=0.088). Odds ratio (OR) for the pregnancy if duration of infertility <5 years was 2.0 (95% CI 1.07; 3.81; p=0.031); if adequate endometrial peristalsis and perfusion — 2.84 (95% CI 1.32; 6.14; p=0.008) and 2.99 (95% CI 0.82; 10.95; p=0.097) respectively.
CONCLUSIONS
Estrogen prescription is expedient management to restore «thin lining» on behalf of efficacy of ET; different dosage forms have comparable potency and side effects, but transdermal application (Divigel, Orion Corporation, Finland) provides adequate endometrial thickness and perfusion with lower dosage. Independent predictors of successful ET are duration of infertility <5 years; adequate endometrial peristalsis and perfusion; ET of day 5 embryos.
