Thin endometrium problem in IVF programs

Abstract

Objective: There are 42% of cases of pathological endometrial changes in recurrent implantation failure in the world. Hormonal therapy is a simple and accessible way to increase the endometrial thickness in IVF programs, but clear criteria for effective estrogen therapy have not been strictly defined yet. Methods: Observational, comparative, prospective, multicenter study (n = 425). Group 1 (n = 228) received estradiol hemihydrate (Divigel, Orion Corporation, Finland), group 2 (n = 197) received oral estradiol valerate (Proginova, Delpharm Lille, France). Results: An increase in endometrial thickness was comparable (10.1 (2.0) mm versus 10.0 (2.3) mm; p =.571). There was significantly shorter mean duration of estrogen therapy (13.9 (3.9) days versus 14.7 (4.7) days; p =.038) and lower total dose in group 1 (43.6 (27.3) mg versus (71.9 (37.2) mg; p =.0001). Pregnancy rates were comparable (143/228 (62.7%) versus 105/197 (53.3%); p =.077) so as “take home baby” rates (80/228 (35.1%) versus 68/197 (34.5%); p =.077). Conclusion: Estrogens improve the state of the endometrium and increase pregnancy rates in cases of thin endometrium in in vitro fertilization programs. The use of transdermal estrogens (Divigel, Orion Corporation, Finland) ensures an adequate increase in endometrial thickness and significantly lower estrogen doses.