Factors Associated with Effectiveness of Treatment and Reproductive Outcomes in Patients with Thin Endometrium Undergoing Estrogen Treatment

Abstract

Background:Thin endometrium is associated with poor reproductive outcomes; estrogen treatment can increase endometrial thickness (EMT). The aim of this retrospective cohort study was to investigate the factors influencing the effectiveness of estrogen treatment and reproductive outcomes after the treatment in patients with thin endometrium.Methods:Relevant clinical data of 101 patients with thin endometrium who had undergone estrogen treatment were collected. Possible factors influencing the effectiveness of treatment were analyzed retrospectively by logistic regression analysis. Eighty-seven infertile women without thin endometrium who had undergone assisted reproduction served as controls. The cases and controls were matched for age, assisted reproduction method, and number of embryos transferred. Reproductive outcomes of study and control groups were compared using Student's t-test and the Chi-square test.Results:At the end of estrogen treatment, EMT was ≥8 mm in 93/101 patients (92.1%). Effectiveness of treatment was significantly associated with maximal pretreatment EMT (P = 0.017) and treatment duration (P = 0.004). The outcomes of assisted reproduction were similar in patients whose treatment was successful in increasing EMT to ≥8 mm and the control group. The rate of clinical pregnancy in patients was associated with the number of good-quality embryos transferred in both fresh (P = 0.005) and frozen-thawed (P = 0.000) embryo transfer cycles.Conclusions:Thinner EMT before estrogen treatment requires longer treatment duration and predicts poorer treatment outcomes. The effectiveness of treatment depends on the duration of estrogen administration. Assisted reproductive outcomes of patients whose treatment is successful (i.e., achieves an EMT ≥8 mm) are similar to those of controls. The quality of embryos transferred is an important predictor of assisted reproductive outcomes in patients treated successfully with exogenous estrogen.

Association between serum estradiol level on the human chorionic gonadotrophin administration day and clinical outcome

“…In COH cycles, serum estradiol ( E 2 ) levels can be increased by more than ten-fold over the levels found during spontaneous cycles. [1] Previous studies have shown that E 2 plays a key role in the regulation of uterine preparation for embryo implantation, via the stimulation of endometrial proliferation [2] and enhancement of uterine and endometrial perfusion. [3] Adequate endometrial preparation is essential to achieve and maintain pregnancy.…”

Effectiveness of electroacupuncture for thin endometrium in infertile women: study protocol for a single-blind, randomized controlled trial

“…Although there are many current treatment strategies for thin endometrium, they have some unsatisfactory deficiencies and lack sufficient evidence of efficacy. Exogenous estrogen treatment is the most widely used and convenient method [ 10 ]; the risk of estrogen therapy in promoting endometrial and breast neoplasms has been clarified over the past 3 to 4 decades [ 40 , 41 ]. In addition, a clinical trial revealed that estradiol supplementation starting on the human chorionic gonadotropin (HCG) day for the patients with thin endometrium did not provide any benefit on the pregnancy outcome in intracytoplasmic sperm injection (ICSI) cycles [ 42 ].…”

“…Incidences of thin endometrium in ovarian stimulation cycles and natural cycles are 38–66% [ 8 ] and 5–25% [ 9 ], respectively. In fresh or frozen-thawed embryo transfer cycles, thin endometrium often leads to cancelation of ET and cryopreservation of all the embryos [ 10 ]. A thin endometrium is associated with low conception rate [ 11 – 13 ], but also to a higher probability of spontaneous abortion and ectopic pregnancy [ 14 ].…”

Effectiveness of Electroacupuncture for Thin Endometrium in Infertile Women: Study Protocol for A Single-Blind, Randomized Controlled Trial

“…Incidences of thin endometrium in ovarian stimulation cycles and natural cycles are 38%-66% [8] and 5%-25% [9], respectively. In fresh or frozen-thawed embryo transfer cycles, thin endometrium often leads to cancelation of ET and cryopreservation of all the embryos [10]. A thin endometrium is not only associated with low conception rate [11][12][13], but also to a higher probability of spontaneous abortion and ectopic pregnancy [14].…”

“…Current therapeutic strategies for thin endometrium include long-term administration of exogenous estrogen, low-dose of aspirin, vaginal sildena l citrate application, transvaginal endometrial perfusion of granulocyte colony-stimulating factor (G-CSF), autologous platelet-rich plasma infusion (PRP), stem cell therapy, vitamins C and E, and L-arginine supplement [8,20]. While exogenous estrogen treatment is the most widely used and convenient method [21], the risk of estrogen therapy in promoting endometrial and breast neoplasms has been clari ed over the past 3 to 4 decades [22,23]. In addition, a clinical trial revealed that estradiol supplementation starting on the human chorionic gonadotropin (HCG) day for the patients with thin endometrium did not provide any bene t on the pregnancy outcome in intracytoplasmic sperm injection (ICSI) cycles [24].…”