scholarly journals Nomogram to Predict an Endometrial Thickness >7.5 mm in the Frozen Embryo Transfer Cycle for Thin Endometrial Women

2021 ◽  
Author(s):  
Zizhen Guo ◽  
Wei Chen ◽  
Yuqing Wang ◽  
Ran Chu ◽  
Xinxin Xu ◽  
...  
Keyword(s):  
Embryo Transfer ◽  
Ovarian Stimulation ◽  
Endometrial Thickness ◽  
Frozen Embryo Transfer ◽  
Natural Cycle ◽  
Stimulation Protocol ◽  
Final Model ◽  
Thin Endometrium ◽  
Endometrial Preparation ◽  
Hcg Trigger

Abstract Background A sufficient endometrial thickness (EMT) is essential for successful pregnancy. For patients with a thin endometrium (EMT ≤7.5 mm on human chorionic gonadotropin [HCG] trigger day) in IVF, some studies have suggested freezing all embryos and preparing the endometrium in the subsequent frozen-thawed cycle, but not all patients can obtain a thicker endometrium during endometrial preparation in the frozen embryo transfer cycle than on HCG trigger day in the fresh embryo transfer cycle. This study aimed to investigate which characteristics of patients with a thin endometrium suggest the possibility of EMT >7.5 mm in the subsequent frozen cycle, and build up a prediction nomogram.Methods Data were collected from the university-based reproductive medical center between January 2013 and September 2019. Multivariable logistic regression was used to generate the final prediction model and construct the nomogram. Model performances were quantified by discrimination and calibration.Results The predictive variables that entered the final model were: hysteroscopic adhesiolysis history, PCOS status, application of clomiphene in the ovarian stimulation process, the ovarian stimulation protocol, and the endometrial preparation protocol. The receiver operating characteristic curve for the final model and validation cohort was 0.76 (95% confidence interval [CI]: 0.722–0.797) and 0.71 (95% CI: 0.66–0.76), respectively. Discrimination performed well in both the modeling and validation cohorts.Conclusion We conclude that in women with a thin endometrium (EMT ≤7.5 mm on HCG trigger day), the absence of a hysteroscopic adhesiolysis history, and the presence of PCOS, the application of clomiphene in the ovarian stimulation process, the application of a GnRH agonist short protocol, mild stimulation protocol, natural cycle protocol, and natural cycle for endometrial preparation are prognostic for an increased possibility of EMT >7.5 mm in the subsequent frozen cycle.

scholarly journals The incidence rate of unresponsive thin endometrium in frozen embryo transfer cycles: A case-series of therapy with granulocyte colony stimulating factor

2019 ◽  
Author(s):  
Shokouhosadat Miralaei ◽  
Mahnaz Ashrafi ◽  
Arezoo Arabipoor ◽  
Zahra Zolfaghari ◽  
Saeideh Taghvaei
Keyword(s):  
Embryo Transfer ◽  
Endometrial Thickness ◽  
Case Series ◽  
Frozen Embryo Transfer ◽  
Granulocyte Colony Stimulating Factor ◽  
Colony Stimulating Factor ◽  
Cross Sectional ◽  
Thin Endometrium ◽  
Stimulating Factor

Background: Treatment-resistant thin endometrium (TTE) during in-vitro fertilization is a relatively uncommon and challenging problem. Objective: The primary aim of the study was to assess the TTE rate during frozen embryo transfer (FET) cycles and the secondary aim was to evaluate the effect of intrauterine instillation of granulocyte colony stimulating factor (G-CSF) in these cases. Materials and Methods: In this cross-sectional study, all of the women who underwent FET cycles with hormonal endometrial preparation in Royan Institute from June 2015 to March 2018 were evaluated and all of the cases with TTE diagnosis (endometrial thickness < 7 mm after using high doses of estradiol) were included. In the eligible cases, 300 μgr of G-CSF was infused intrauterine. If the endometrium had not reached at least a 7-mm, a second infusion was prescribed within 48 hr later. Results: During the study, 8,363 of FET cycles were evaluated and a total of 30 infertile patients (0.35%) with TTE diagnosis were detected. Finally, 20 eligible patients were included. The changes of endometrial thickness after G-CSF therapy were significant (p< 0.001); however, the endometrial thickness did not reach 7 mm in nine patients (45%) and the embryo transfer was canceled. Conclusion: It was found that the rate of TTE during the FET cycle is very low and intrauterine perfusion of G-CSF has a potential effect to increase the endometrial thickness in these patients; however, the rate of cancellation was still high and poor pregnancy outcomes were observed. Key words: Granulocyte colony-stimulating factor, Cryopreservation, Embryo transfer, Endometrial diseases.

scholarly journals Treatment of unexplained thin endometrium with autologous platelet-rich plasma in a frozen embryo transfer cycle

2019 ◽  
Vol 2 (2) ◽  
pp. 80-82
Author(s):  
Sara Mahmood ◽  
Salma Kafeel ◽  
Riffat Bibi ◽  
Naveed Iqbal
Keyword(s):  
Embryo Transfer ◽  
Endometrial Thickness ◽  
Platelet Rich Plasma ◽  
Uterine Cavity ◽  
Blastocyst Stage ◽  
Frozen Embryo Transfer ◽  
Thin Endometrium ◽  
Autologous Platelet Rich Plasma ◽  
Autologous Platelet ◽  
Endometrial Proliferation

Inadequate endometrial proliferation is a known cause of implantation failure in assisted reproductive technology cycles. It is generally agreed that >9 mm endometrial thickness is associated with higher implantation. Several strategies have been explored to enhance endometrial proliferation. However, the results are either poor, inconsistent or subject to safety concerns. A 34-year old woman presented with unexplained thin endometrium in successive frozen embryo transfer (FET) cycles. Autologous platelet-rich plasma (PRP) was infused in the uterine cavity on day 10 of second FET cycle enhancing endometrial thickness, which post-PRP infusion measured 10.9 mm. Blastocyst-stage embryos were transferred resulting in a successful pregnancy. Autologous intrauterine infusion of PRP positively impacts endometrial proliferation and implantation which is safe, low resource and minimally invasive.

P–677 Endometrial thickness, endometrial preparation protocol and number of euploid embryos transferred, significantly impact the live birth in frozen embryo transfer cycles

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
A Liñá. Tegedor ◽  
I Elkhatib ◽  
A Abdala ◽  
A Bayram ◽  
K Ab. Ali ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Embryo Transfer ◽  
Live Birth ◽  
Birth Rate ◽  
Endometrial Thickness ◽  
Live Birth Rate ◽  
Frozen Embryo Transfer ◽  
Endometrial Preparation ◽  
The Impact ◽  
Ploidy Status

Abstract Study question Is the live birth rate (LBR) in euploid frozen embryo transfer (FET) cycles affected by the endometrial thickness (EMT)? Summary answer A significantly higher LBR was observed in patients with an endometrial thickness of at least 7.5mm (46.24% vs. 54.63%) What is known already Parameters assessing the endometrium prior planning a FET include endometrial thickness, pattern and blood flow. The impact of the endometrial thickness on ART outcomes is controversial, with conflicting results published. A recent meta-analysis evaluated whether EMT could predict pregnancy outcomes and suggested that lower EMT was associated with lower incidence of clinical pregnancy rate (CPR), implantation rate (IR) and LBR. Due to heterogeneity of parameters evaluated between different publications, where embryos with unknown ploidy status were transferred, in conjunction with variability of stimulation protocols and the number of embryos transferred, the real effect of the EMT was difficult to infer. Study design, size, duration This was a two-center retrospective observational study including a total of 1522 euploid FET cycles between March 2017 and March 2020 at ART Fertility Clinics Muscat, Oman and Abu Dhabi, UAE. Participants/materials, setting, methods Trophectoderm biopsies were analyzed with Next Generation Sequencing (NGS). Vitrification/warming of blastocysts was performed using Cryotop method (Kitazato). EMT was measured by vaginal ultrasound prior initiating the progesterone administration (± 1 day) and LBR was recorded. Multivariate analysis was performed between LB outcomes and median EMT while controlling for confounding factors. Main results and the role of chance A total of 1522 FET cycles were analyzed: 975 single embryo transfer (SET) and 547 double embryo transfer (DET). The mean age of the patients was 33.38 years with a mean BMI of 27.1 kg/m2. FET were performed in EMT ranging from 3 to 15 mm and 50.52% resulted in a live birth. Though potentially all ranges of EMT were associated with LB, the median EMT in patients with LB was significantly higher than the median EMT of patients without LB (7.6mm vs. 7.4mm; p &lt; 0.001). The dataset was stratified into two groups based on the median EMT (7.5mm): &lt; 7.5mm (n = 744 cycles) and ≥ 7.5mm (n = 778 cycles). A significantly higher live birth rate was observed in ≥ 7.5mm group (46.24% vs. 54.63%. p = 0.0012). In multivariate analysis, EMT, FET endometrial preparation protocol, and number of embryos transferred were the main parameters influencing the chance to achieve LB: OR 1.10 [1.01–1.19], p &lt; 0.015 for the EMT; OR 1.84 [1.47–2.30], p &lt; 0.0001 for Natural Cycle protocol and OR 1.55 [1.25–1.93], p &lt; 0.0001 for DET. Intercept 0.18 [0.07–0.44] p &lt; 0.0002. Female age did not reach significance: OR 1.02 [1.00–1.04], p = 0.056. Limitations, reasons for caution Besides the retrospective nature of the study, the inter-observer variability in EMT assessment between different physicians is a limitation. The physician and embryologist performing the embryo transfer could not been standardized due to the multicenter design of the study. Wider implications of the findings: The EMT in FET may influence the LBR and should be considered as an important factor for the success of embryo transfer cycles. Whether these results can be extrapolated to fresh embryo transfer and to blastocysts with unknown ploidy status, needs further investigation. Trial registration number Not applicable

scholarly journals Successful live birth in a Chinese woman with P450 oxidoreductase deficiency through frozen-thawed embryo transfer: a case report with review of the literature

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Ping Pan ◽  
Lingyan Zheng ◽  
Xiaoli Chen ◽  
Jia Huang ◽  
Dongzi Yang ◽  
...  
Keyword(s):  
Embryo Transfer ◽  
Hormonal Control ◽  
Frozen Embryo Transfer ◽  
Chinese Woman ◽  
Primary Amenorrhea ◽  
Compound Heterozygous ◽  
Thin Endometrium ◽  
P450 Oxidoreductase ◽  
Endometrial Preparation ◽  
Oral Dexamethasone

Abstract Background Congenital adrenal hyperplasia (CAH) caused by P450 oxidoreductase deficiency (PORD) in 46, XX patients is characterized by genital ambiguity, primary amenorrhea, absent or incomplete sexual maturation, infertility, skeletal malformations and so on. But few pregnancies have been reported from these female patients with PORD. Case description A 29-year-old Chinese woman with PORD due to the compound heterozygous mutation (c.1370G > A/c.1196_1204del) in the P450 oxidoreductase (POR) gene had suffered from primary amenorrhea and infertility. She had one cancelled cycle of ovulation induction due to low serum estradiol(E2), high progesterone(P) levels and thin endometrium, then in vitro fertilization (IVF) was recommended. At the first IVF cycle, 4 oocytes were retrieved and 4 viable embryos were cryopreserved due to thin endometrium associated with low E2 and prematurely elevated P after ovarian stimulation, even though oral dexamethasone were used to control adrenal P overproduction at the same time. When basal P fell to < 1.5 ng/ml after the therapy of oral dexamethasone, artificial endometrial preparation and frozen embryo transfer were performed, resulting in a twin pregnancy. She delivered a healthy boy and a healthy girl by caesarean section at 37 weeks and 2 days of gestation. After the literature search in PORD women, no spontaneous pregnancy has been reported and only two previous case reports of 3 successful pregnancies through IVF were summarized. Conclusions It is the third report that successful pregnancy was achieved in a CAH woman caused by a compound heterozygous POR mutation, with primary amenorrhea and disorders of steroidogenesis. It seemed that disorders of steroidogenesis caused by PORD didn’t impair the developmental potential of oocytes. IVF and frozen embryo transfer after adequate hormonal control and endometrial preparation should be an effective infertility treatment for PORD women.

scholarly journals Successful live birth in a Chinese woman with P450 oxidoreductase deficiency through frozen-thawed embryo transfer and review of the literature

2020 ◽  
Author(s):  
Ping Pan ◽  
Lingyan Zheng ◽  
Xiaoli Chen ◽  
Jia Huang ◽  
Dongzi Yang ◽  
...  
Keyword(s):  
Embryo Transfer ◽  
Hormonal Control ◽  
Frozen Embryo Transfer ◽  
Chinese Woman ◽  
Primary Amenorrhea ◽  
Compound Heterozygous ◽  
Thin Endometrium ◽  
P450 Oxidoreductase ◽  
Endometrial Preparation ◽  
Genital Ambiguity

Abstract Background: Congenital adrenal hyperplasia (CAH) caused by P450 oxidoreductase deficiency (PORD) in 46,XX patients is characterized by genital ambiguity, primary amenorrhea, absent or incomplete sexual maturation, infertility, skeletal malformations and so on. But few pregnancies have been reported from these female patients with PORD. Case Description: A 29-year-old Chinese woman with PORD due to the compound heterozygous mutation (c.1370G>A/c.1196_1204del) in the P450 oxidoreductase( POR ) gene had suffered from primary amenorrhea and infertility. She had one cancelled cycle of ovulation induction due to low serum estradiol(E 2 ), high progesterone(P) levels and thin endometrium,then in vitro fertilization (IVF) was recommended. At the first IVF cycle, 4 oocytes were retrieved and 4 viable embryos were cryopreserved due to thin endometrium associated with low E 2 and prematurely elevated P after ovarian stimulation, even though oral dexamethasone were used to control adrenal P overproduction at the same time. When basal P fell to <1.5ng/ml, artificial endometrial preparation and frozen embryo transfer were performed, resulting in a twin pregnancy. She delivered a healthy boy and a healthy girl by caesarean section at 37 weeks and 2 days of gestation. Conclusions: We report the pregnancy achieved in a CAH woman caused by a compound heterozygous POR mutation, with primary amenorrhea and disorders of steroidogenesis. It seemed that disorders of steroidogenesis caused by PORD didn’t impair the developmental potential of oocytes. IVF and frozen embryo transfer after adequate hormonal control and endometrial preparation should be an effective infertility treatment for PORD women.

scholarly journals Successful Live Birth in a Chinese Woman with P450 Oxidoreductase Deficiency through Frozen-thawed Embryo Transfer

2020 ◽  
Author(s):  
Ping Pan ◽  
Lingyan Zheng ◽  
Xiaoli Chen ◽  
Jia Huang ◽  
Dongzi Yang ◽  
...  
Keyword(s):  
Embryo Transfer ◽  
Hormonal Control ◽  
Frozen Embryo Transfer ◽  
Chinese Woman ◽  
Primary Amenorrhea ◽  
Compound Heterozygous ◽  
Thin Endometrium ◽  
P450 Oxidoreductase ◽  
Endometrial Preparation ◽  
Genital Ambiguity

Abstract Background: Congenital adrenal hyperplasia (CAH) caused by P450 oxidoreductase deficiency (PORD) in 46,XX patients is characterized by genital ambiguity, primary amenorrhea, absent or incomplete sexual maturation, infertility, skeletal malformations and so on. But few pregnancies have been reported from these female patients with PORD. Case Description: A 29-year-old Chinese woman with PORD due to the compound heterozygous mutation (c.1370G>A/c.1196_1204del) in the P450 oxidoreductase(POR) gene had suffered from primary amenorrhea and infertility. She had one cancelled cycle of ovulation induction due to low serum estradiol(E2), high progesterone(P) levels and thin endometrium，then in vitro fertilization (IVF) was recommended. At the first IVF cycle, 4 oocytes were retrieved and 4 viable embryos were cryopreserved due to thin endometrium associated with low E2 and prematurely elevated P after ovarian stimulation, even though oral dexamethasone were used to control adrenal P overproduction at the same time. When basal P fell to <1.5ng/ml, artificial endometrial preparation and frozen embryo transfer were performed, resulting in a twin pregnancy. She delivered a healthy boy and a healthy girl by caesarean section at 37 weeks and 2 days of gestation. Conclusions: We report the pregnancy achieved in a CAH woman caused by a compound heterozygous POR mutation, with primary amenorrhea and disorders of steroidogenesis. It seemed that disorders of steroidogenesis caused by PORD didn’t impair the developmental potential of oocytes. IVF and frozen embryo transfer after adequate hormonal control and endometrial preparation should be an effective infertility treatment for PORD women.

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