Introduction
One of the most challenging problems in in vitro fertilization (IVF) is patient with thin endometrium. The objective of the study was to ascertain whether daily human chorionic gonadotropin (hCG) for 7 days with estrogen in hormone replacement frozen embryo transfer (FET) cycles during follicular phase can increase the endometrial thickness (ET) and reduce the cancellation of cycles.
Materials and methods
Twenty-five infertile patients with resistant thin endometrium who had antagonist protocol and planned for frozen embryo replacement were recruited. These patients had prior attempts to thicken their endometrium which had failed. All the patients received estrogen daily from D2/3 of cycle. On day 8 or 9 of estrogen administration, 200 IU of hCG was given daily for 7 days. After 7 days on hCG priming (D14/15), ET was measured and progesterone was started accordingly. Identification of an intrauterine gestational sac with fetal heart beat by transvaginal ultrasonography constituted clinical pregnancy.
Results
Mean ET increased significantly from 5.84 to 7.61 mm (p < 0.01). About 72% of patients had more than 20% improvement in their ET after hCG priming. About 76% achieved an ET more than 7 mm. Overall, 50% became pregnant. The ongoing pregnancy rate was 40%.
Conclusion
A total of 200 IU hCG endometrial priming for 7 days in the proliferative phase of hormone replacement cycles for FET is a highly promising approach to thicken thin endometrium with failed prior attempts.
How to cite this article
Nigam S, Shankar K, Varma TR. Role of Low-dose Human Chorionic Gonadotropin in Follicular Phase for Thin Endometrium in Frozen Embryo Replacement Cycles in in vitro Fertilization/Intracytoplasmic Sperm Injection Patients: A Pilot Study. Int J Infertil Fetal Med 2017;8(3):101-105.
Introduction:In assisted reproduction technique cycles, controlled ovarian stimulation (COS) leads to supraphysiological levels of steroid hormone secretion and the subsequent need for luteal phase support (LPS). Therefore, existing data on the steroid secretion profile in the luteal phase of spontaneous conception cycles and its predictive value for pregnancy outcome need to be discussed against the background of preceding COS. The clinical significance of luteal phase hormones, such as estrogen (E2) and progesterone (P4), in predicting pregnancy after controlled ovarian hyperstimulation protocols for in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) is still poorly understood. The aim of the present study was to investigate the role of midluteal serum E2 and P4 level in predicting successful pregnancy in patients undergoing IVF/ICSI.
Materials and methods:One hundred fifteen women were recruited for the study. They were given gonadotropin-releasing hormone antagonist protocol and human chorionic gonadotropin (hCG) was administered if at least three follicles were more than 18 mm in size. Transvaginal ultrasound-guided oocyte retrieval followed by ICSI and embryo transfer (ET) was done. Post-ET, all women had same LPS. The E2 and P4 measurements were done at day of ET (day 0) and 9 days post-ET (day 9). Levels of E2 and P4 were compared between those who subsequently became pregnant and those who could not achieve pregnancy. Statistical analysis was performed using Statistical Package for the Social Sciences.Results: Forty-six (40%) achieved pregnancy. The E2 and P4 levels on day 9 were significantly higher in those who achieved pregnancy (p < 0.01). Out of 46 pregnancies, 38 were ongoing viable pregnancies.
Conclusion:Luteal phase E2 and P4 can be used as prognostic marker to predict pregnancy in IVF/ICSI cycles.
Keywords:Midluteal estrogen and progesterone levels, Pregnancy outcome in in vitro fertilization/intracytoplasmic sperm injection cycles, Prospective study.ijifm ORiGiNAL ARTiCLE
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