Hormone replacement therapy alone or in combination with tamoxifen in women with thin endometrium undergoing frozen-thawed embryo transfer: A retrospective study

Abstract

Research questionTo investigate the effects of two protocols (hormone replacement therapy (HRT) alone or in combination with tamoxifen) on the endometrium and pregnancy outcome of patients with thin endometrium in frozen-thawed embryo transfer (FET) cycles.DesignA total of 465 infertile patients with thin endometrium who underwent FET between January 2020 to June 2021 at the Drum Tower Hospital affiliated with Nanjing University Medical School were retrospectively analyzed. A total of 187 patients were given tamoxifen in addition to HRT (TMXF-HRT group), whereas 278 patients were given only HRT (HRT group). Clinical data were compared between the two groups, including general characteristics, endometrial thickness, and clinical pregnancy outcomes.ResultsThere were no significant differences in baseline characteristics of all enrolled patients between two groups. Serum progesterone (P) was higher in HRT group than in the TMXF-HRT group (0.28 ± 0.53 ng/mL vs. 0.15 ± 0.25 ng/mL, P = 0.002). There was a significant increase in endometrial thickness in the TMXF-HRT group compared with the HRT group (OR: 1.54, 95% CI: 1.32-1.75, P < 0.001). There were no significant differences in the clinical pregnancy rate, embryo implantation rate, early miscarriage rate, or live birth rate between these two groups.ConclusionAlthough tamoxifen when used in combination with hormone replacement therapy can significantly increase endometrial thickness, it may not have a role in improving the pregnancy outcomes of patients with thin endometrium undergoing FET cycles.

Autologous Platelet-Rich Plasma (PRP) in Infertility—Infusion versus Injectable PRP

“…Adjuvant therapy such as tamoxifen proved an increase in endometrial thickness but not in the pregnancy rate [18]. Another type of adjuvant therapy would be sildenafil-citrate use, which is associated with a higher pregnancy rate and not so much with endometrial thickness but with the receptivity and improved vascularization of the endometrium [19,20]. The classic hormonal therapy endometrial preparation in the frozen embryo transfer cycles (FET cycles) has the same pregnancy rate under 7 or 14 days of exposure to estradiol with similar estradiol levels, according to Racca A. et al [21].…”

“…This approach resulted in the collection of an average of 4-5 mL of plasma, with at least 2 mL injected into both the anterior and posterior uterine walls. It is worth noting that there is currently no consensus in the medical community regarding the optimal volume of PRP, the number of activated platelets per unit volume, the volume of blood to be collected, or the platelet count in the initial sample [7,10,20].…”

New advances in the treatment of thin endometrium

“…As an antitumor drug, it has both anti-estrogenic and estrogen-like effects, and plays different roles in different target organs, inhibiting breast tumors while promoting endometrial hyperplasia. Combination TMX+hormone replacement therapy (HRT) in patients with infertility with TE (EMT <8mm) increased EMT more than HRT alone; however, differences in clinical pregnancy outcomes (CPR, embryo IR, early miscarriage rate, LBR) did not differ significant between these groups ( 34 ).…”