Lack of correlation between hormonal blood levels and endometrial maturation in agonadal women with repeat implantation failure following embryo transfer from donated eggs

Abstract

Five women with ovarian failure who repeatedly failed to conceive following embryo transfer from donated eggs underwent endometrial development investigation. One endometrial biopsy was obtained on cycle days 19, 21, and 23 during three consecutive artificially induced cycles. All five patients had only early secretory changes on days 19 and 21. Histological evaluation on cycle day 23 revealed various developmental stages: two women had "in-phase" endometrium, two patients had adequately developed stroma but significantly retarded glandular maturation, and one women showed no progress. The histological findings were conclusive for a significant maturation delay and an impaired endometrial receptivity. There was a lack of correlation between the peripheral hormonal blood levels and the endometrial maturation.

The choice of luteal support following pituitary down regulation, controlled ovarian hyperstimulation and in vitro fertilization

“…Progesterone is crucial for implantation 4 as it induces secretory changes in the endometrium essential for implantation to occur. However, serum levels of progesterone do not always correlate with expected histological findings 5 and local factors acting at the site of implantation are also likely to be important, not to mention the quality of the embryo 3 . It is thus difficult to establish the minimum progesterone requirement, which is further complicated by the lack of standardised progesterone assays 6 .…”

Choice and Precycle Preparation of Prospective Oocyte Donors and Recipients

“…16 ' 17 In a further study of 5 women who had repeated failures of oocyte donation, all were found subsequently to have only early secretory changes on a cycle day 21 endometrial biopsy. 18 These studies would imply either that higher doses of progesterone may improve implantation in such women or that a subset of women can be identified who have little chance of success regardless of treatment modifications. The proper study has not been done to determine if dose modification will increase success.…”