Efficacy of estradiol supplement therapy for patients with thin endometrium in intrauterine insemination cycles / 대한산부인과학회잡지

OBJECTIVE: To evaluate the endometrial response and to compare the pregnancy outcome of estradiol supplement in patients with abnormally thin endometrium who are undergoing IUI. METHODS : From November 1st, 1998 to February 28th, 2001, 914 IUI cycles were studied and which were divided into several groups. In preparatory cycle, all of the patients were prepared with conjugated estrogen. The patients were divided into several groups according to the endometrial thickness (ET). Control I (n=734) was normal control group (ET>or=7 mm). Control II (n=67) was control group with abnormally thin endometrium (ETintrauterine insemination7 mm) without estradiol supplement. Group I (n=65) and group II (n=48) had thin endometrial thickness. However, in preparatory cycle, the endometrial thickness was more than 7 mm in group I and was less than 7 mm in group II. Uterine preparation consisted of 6-8 mg of estradiol valerate. The number of natural cycle was 234 and the hyperstimulation protocol used were clomiphene (n=250), clomiphene/ hMG (n=214), hMG (n=216). RESULTS: The average pregnancy rate in group I was 15.4%. There was no significant difference between control I (21.1%) and group I. The pregnancy rate in control II and group II was significantly decreased (3.0 vs. 6.3%) compared with control I and group I. In control I and group I, average endometrial thickness and pregnancy rate were decreased when clomiphene was used compared with hMG alone. (endometrial thickness control I 8.4 +/- 0.6 vs. 10.0 +/- 0.7 mm, group I 6.9 +/- 0.8 vs. 7.9 +/- 0.7 mm, pregnancy rate control I 14.6 vs. 29.8%, group I 9.1 vs. 31.3%). CONCLUSION: The adequate endometrial thickness is an important prognostic factor for implantation and is achieved with administration of estradiol supplement in patients with abnormally thin endometrium who responded to exogenous estradiol with endometrial thickness up to 7 mm in evaluation cycle.

Effectiveness of Estradiol and Sildenafil supplement therapy in IVF-ET patients with thin endometrium / 대한산부인과학회잡지

OBJECTIVE: The purpose of this study was to evaluate the effect of estradiol (E2) only/and sildenafil supplement on controlled ovarian hyperstimulation and pregnancy outcome in patients undergoing IVF-ET cycles. METHODS: Total 104 cycles of IVF-ET patients were included in this study, which had been undergone controlled ovarian hyperstimulation (COH) with long protocol in Eulji infertility center and Ilsan Grace hospital between January 1999 and December 2000. Group 1 (COH only) consisted of 34 cycles, group 2 (COH+estradiol supplement) consisted of 35 cycles, and group 3 (COH+estradiol/sildenafil supplement) consisted of 35 cycles. RESULTS: With E2 and/only Sildenafil supplement, improvement of the endometrial thickness (P<0.05) and clinical pregnancy rate (P<0.05) were obtained. There was no significant increase in pregnancy rate with sildenafil supplement compared to E2 supplement only (20.0% versus 25.7%). However, rather short duration of controlled ovarian hyperstimulation (13.3+/-1.7 days versus 11.7+/-1.7 days) was found in the group that received E2 and sildenafil supplementation. (P<0.1) CONCLUSION: In patients with thin endometrium, the sildenafil supplement might lead to increase endometrial receptivity, and in consequence improvement of pregnancy rate. Sildenafil may augment the vasodilatory effect of nitric oxide by inhibition of cGMP hydrolysis, by improving ovarian perfusion, stimulates follicular development thus might shorten the duration of controlled ovarian hyperstimulation in IVT-ET cycles as we observed in our study.