Endometrial but not Ovarian Response is Associated With Clinical Outcomes and can be Improved by Prolonged Pituitary Dow
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Reproductive Sciences 1-8 ยช The Author(s) 2018 Article reuse guidelines: sagepub.com/journals-permissions DOI: 10.1177/1933719118816835 journals.sagepub.com/home/rsx
Jianyuan Song, MD1, Xuejiao Sun, MD2, and Kun Qian, MD, PhD1
Abstract The aim of this study is to investigate the effect of ovarian and endometrial response on live birth rates (LBRs) in young normal and high responders and prolonged pituitary downregulation on endometrial receptivity and clinical outcomes in patients with different endometrial thickness. Between January 2013 and December 2017, 9511 patients underwent first in vitro fertilization (IVF)/ intracytoplasmic sperm injection (ICSI) cycles with age 35 years, follicle stimulating hormone < 10 IU/l, and 4 retrieved oocytes were conducted. The estradiol (E2) levels on the human chorionic gonadotropin (HCG) day were classified into 4 groups: group 1 ( .05). Binary logistic regression analysis suggested that EMT but not E2 levels was one of the independent predictive factors of LBRs (odds ratio 0.889, 95% confidence interval, 0.865-0.914, P < .001). The prolonged protocol had significantly higher implantation rates and clinical pregnancy rates in patients with medium (7 < EMT < 14 mm), especially thin endometrium (7 mm) compared to short GnRH-a long protocol. Our study showed that endometrial response but not ovarian response was associated with LBRs in young normal and hyper responders. Prolonged pituitary downregulation was an effective treatment to improve endometrial receptivity in patients with medium, especially thin endometrium. Keywords estradiol level/endometrial thickness/live birth rate/IVF
Introduction The optimization of ovarian response to controlled ovarian stimulation (COS) for in vitro fertilization (IVF) is extremely important. Based on the number of oocytes retrieved or serum estradiol (E2) levels on HCG day, ovarian response is commonly defined as poor, normal, or hyper.1 A poor response to COS potentially results in high cancelation rates, decreased numbers of embryos available for transfer, and poor pregnancy rate compared to normal responders.2 However, the relationship between ovarian response and live birth in normal and high responders is poorly understood.3 In general, the increased number of follicles improved pregnancy rates in women undergoing IVF/ICSI, not only by increasing the number of available embryos but also by allowing extended embryo culture and enabling the selection of the best quality embryo for transfer.4 But on the other hand, aggressive COS necessary for multiple follicular developments
is accompanied by supraphysiological serum estradiol (E2) levels and progesterone (P) levels. Thus, the endometrium and embryo could be exposed to this supraphysiological internal environment, which may influence clinical pregnancy outcomes.5 Endometrial response (endometrial thickness, EMT) is a key factor in the identification of endometrial receptivity.6 A thin endometrium is generally defined as 7 mm on the day of
1 Reproductive Medicine Centre, Tongji Hosp
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