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Our experience demonstrates that a significant proportion of patients with a history of implantation failure of a euploid embryo have a displaced WOI as detected by the ERA. For these patients, pET using a modified progesterone protocol may improve the outcomes of subsequent euploid FET. Larger randomized studies are required to validate these results.

Background Premenopausal women undergoing chemotherapy are at risk for amenorrhea and impaired fertility. Our objective was to assess levels of Mullerian Inhibitory Substance (MIS), Estrodiol(E2), Follicle Stimulating Hormone(FSH) and menstrual status, in women undergoing chemotherapy. Patients and Methods We conducted a nested prospective cohort study in women aged <40 years with breast cancer (BC) undergoing adjuvant chemotherapy (n=26). Serum MIS, FSH, and E2 were measured before chemotherapy (baseline) and at weeks 6, 12, 36 and 52. Controls were 134 age-matched women with known fertility. Hormone levels were compared between the cases and controls at baseline. Differences between amenorrhea and age subgroups were tested with the non-parametric Wilcoxon two-sample test using a two-sided alpha of 0.05. Results Subjects with BC and age-matched controls had similar baseline MIS levels (median 0.94 vs. 0.86 ng/ml, p>0.05). Serum MIS decreased significantly at 6 weeks and remained suppressed for 52 weeks. E2 levels decreased, and FSH levels increased during chemotherapy, however, at 52 weeks, the levels returned to baseline. At 52 weeks, only1 patient had MIS above the lower normal range, 15 had return of menstrual function, 11 had premenopausal levels of FSH, and 13 had follicular phase levels of E2. In women <35, 25% remained amenorrheic, whereas in women over 35, 50% were amenorrheic. Amenorrheic and menstruating women had similar MIS values at baseline and follow-up. Conclusions In young women with BC, chemotherapy decreases MIS rapidly and dramatically. Rapid reductions in MIS do not predict subsequent menstrual function. Ovarian reserve and endocrine function may be affected differently by chemotherapy.