Transfer and uterine factors are the major recipient-related determinants of success with donor eggs

Purpose A thin endometrium is one of the most difficult problems encountered in assisted reproduction every day practice. Whether a daily dose of 150 IU HCG for 7 days concomitant with estrogen administration in estrogen replacement cycles can increase the endometrial thickness and improve pregnancy outcome, was the objective of the current study. Methods Seventeen infertile patients with successive implantation failures and resisting thin endometrium, being recipients of fresh donor or frozen embryos were recruited. This was a prospective cohort, proof of concept study, NCT01768247. On day-8 or 9 of the estrogen administration, and continuing 8 mg estrogen per day, subcutaneous injections of 150 IU HCG were initiated daily for 7 days. After a week on HCG priming, (day-14 or 15) endometrial thickness was controlled with ultrasound, and progesterone was initiated. Results Mean endometrial thickness was increased from 5.2 mm to 6 mm (p=0.008). 35.3 % of the patients had more than 20 % improvement of their endometrial thickness after HCG priming. 17 % achieved an endometrial thickness more than 7 mm, and 29.4 % did not improve their thickness at all. Interestingly, from the later two became pregnant. Overall, 41 % of them (7/17) finally delivered. Conclusions One hundred fifty IU HCG endometrial priming for 7 days in the proliferative phase of estrogen substituted cycles for frozen embryos is highly promising, as not only the thickness of the endometrium improves but also eventually the receptivity appears normalized.

Section: Introductionmentioning

confidence: 99%

“Follicular HCG endometrium priming for IVF patients experiencing resisting thin endometrium. A proof of concept study”

Papanikolaou¹,

Kyrou²,

Zervakakou³

et al. 2013

“…While environmental differences are hypothesized to underlie the observed associations between clinic location and donor egg IVF success, a number of unquantified variables could very well explain the observed directionality of association. Regional practice differences in IVF protocols, such as choice of ovarian suppression strategy, gonadotropin type and dose, and peak estradiol levels prior to ET [49], donor characteristics such as age and sibling donor [50], as well as regional differences in donor egg recipient profiles such as obesity [51], uterine factor [52,53], presence of hydrosalpinges [54] and even vitamin D deficiency [55] could underlie the observed phenomenon. The publically accessible data reported by SART include cumulative annual data for the reporting clinics; details on individual egg donors and recipients are lacking; similarly, in the absence of information on timing of the undertaken ART cycle/s, any inference regarding site specific UVB values during the time of ART cycle, or effect of seasonality cannot be attained.…”

Section: Discussionmentioning

confidence: 99%

“…While a number of patient specific variables are recognized to adversely impact on the success of donor egg IVF [7][8][9][10], contributions of thus far unidentified influences that may modulate the likelihood for procreative success with the use of donor eggs remain a consideration.…”

Section: Introductionmentioning

confidence: 99%

Donor egg IVF model to assess ecological implications for ART success

Pal

Kidwai

Kayani

et al. 2014

Purpose Environmental influences on reproductive success are recognized. We hypothesized that location of fertility clinics may influence treatment success and explored this hypothesis utilizing donor egg IVF (IVF) embryo transfer (ET) model. Methods Publicly accessible national registry data (Society for Assisted Reproductive Technology) on fresh & frozen (FET) ET cycles undertaken at participating clinics across North America (n=444 IVF centers) for 2007 were utilized. Information on number of donor egg IVF cycles, live birth (LB) rate following fresh and frozen ET(FET), average number (#) of ET and IVF center's location, geographical coordinates (latitude, longitude, altitude), annualized average temperatures and midyear regional ultraviolet B (UVB) radiation intensity were obtained. Multivariable logistic regression analyses assessed relationship between LBR (in tertile and uppermost versus lesser quartiles) following fresh and FET with geographical coordinates (region and altitude of clinic location) and ecological influences (average temperature and midyear UVB intensity), adjusting for #ET and clinic experience with donor egg IVF. Results Average number of fresh ET, clinic location (region) and midyear UVB intensity were positive predictors of LBR following fresh ET, whereas altitude and annualized average regional temperature demonstrated an inverse relationship with LBR following fresh ET. For FET cycles, #ET, clinic region and altitude were positive determinants of increasing LBR's. Annualized regional temperature and midyear UVB failed to demonstrate any relationship with LB following donor egg FET. Conclusion Our data suggest that ecological influences may relate to donor egg IVF cycle success. Future studies are needed to better elucidate the mechanisms that could explain the observed associations.

“…Despite the existence of quite a few published studies, the prognostic value of ultrasonographic endometrial thickness measurements (and other parameters) in predicting implantation and pregnancy rates remains controversial. Some investigators have demonstrated a positive correlation between endometrial thickness and pregnancy rates [1][2][3][4][5][6][7][8]11] while others have not found such an association [9,10,[12][13][14], or only in association with other parameters [15,16]. However, these differences may be in part attributed to different patient populations, stimulation protocols used or measurement timing.…”

Section: Discussionmentioning

confidence: 99%

“…While some studies have shown that this parameter is important for predicting the outcome of In Vitro Fertilization (IVF) cycles [1][2][3][4][5][6][7][8], other studies have failed to show such a positive relationship [9][10][11][12][13][14]. In a third category of studies the endometrial thickness was related to the IVF outcome, but only in correlation with other parameters [15,16].…”

Section: Introductionmentioning

confidence: 99%

Thin unresponsive endometrium—a possible complication of surgical curettage compromising ART outcome

Shufaro

Simon

Laufer

et al. 2008

Purpose Endometrial thickness is important for implantation. Little data addresses the etiology of persistently thin endometrium. We present a patient cohort in order to define common features and draw conclusions. Methods Thirteen out of 1,405 IVF patients repeatedly had thin unresponsive endometrium (<7 mm). Age, history, uterine cavity status, treatment type and outcome were examined. Results Patient age was 35.9±5.7 years. Ten patients had a curettage performed previously. Nine patients had normal cavity and endometrium, and in four adhesions were diagnosed and removed. Out of 99 cycles performed afterwards, endometrial thickness increased in 22. ETs were performed in 49 cycles resulting in 11 pregnancies. Their outcome was eight miscarriages, two terminations due to malformations, and one live birth. Conclusions Thin unresponsive endometrium was associated with curettage, not necessarily with intrauterine adhesions. Even if adequate thickening eventually occurred, the reproductive outcome was still very poor. Therefore other alternatives should be sought for these patients.