El defecto inherente del endometrio causa fallo de implantación en Técnica de Reproducción Asistida / Inherent defect of the endometrium causes implantation failure in Assisted Reproductive Technique

Introduction. Implantation failure appears to be a significant factor in Assisted reproductive technique (ART) procedures. Even a mature endometrium may be non-receptive, preventing implantation or rejection of implanted embryo in early months of pregnancy, resulting in miscarriage or unexplained infertility with or without other associated factors. Objective. To investigate causes of failed implantation inspite of uneventful Grade I embryo transfer in ART procedure Material and Method. 90 women aged range between 25-40 yr old who visited Department of Reproductive Medicine at Calcutta Fertility Mission, over a period of 24 months(January 2017 to December 2019) , satisfying the inclusion criteria, were enrolled in this observational study. Endometrial aspirate histopathology was done along with ∞5ß3 integrin expression. They were treated with natural micronized progesterone (NMP) or oral dydrogesterone and results of endometrial changes were statistically analyzed. Results. 28.89% and 31.11% of women were seen to have mid-secretory changes of the endometrium after being treated with NMP and dydrogesterone respectively. Integrins were expressed in only 59.26% of women with mid-secretory endometrium and 5.41% of early secretory endometrium, which was statistically significant (p value <0.001). Conclusion. About 70% patients even after treatment with estrogen and progestin did not have adequate response in endometrial maturation. Not all patients with mid-secretory endometrium had integrin positive, when tested. NMP and oral Dydrogesterone have similar effect in endometrial maturation as well as in yielding successful pregnancy in some patients with previously failed In-vitro fertilization embryo transfer (IVF-ET).

Comparison of oral dydrogesterone with suppository vaginal progesterone for luteal-phase support in in vitro fertilization [IVF]: a randomized clinical trial

Luteal phase support is mandatory in assisted reproductive technologies [ART] for optimizing outcome, so the luteal phase is supported with either progesterone, addition of estradiol to progesterone, hCG or gonadotropin releasing hormone [GnRH] agonists. Supplementation of luteal phase with progesterone is prescribed for women undergoing routine IVF treatment. To compare oral dydrogestrone with vaginal progesterone for luteal-phase support in IVF. We performed this prospective, randomized trial in a tertiary infertility care unit in Taleghani Hospital, Tehran, Iran. In total 80 Women with a history of male factor infertility undergoing controlled ovarian stimulation for IVF treatment [fresh cycle] randomly were divided in two groups [group A or oral dydrogesterone group and group B or vaginal progesterone group]. The inclusion criteria were the use of GnRH analogue down-regulation and age less than 40 years old with regular menstrual cycles. All women were euthyroid and normoprolactinemic. Group A [n=40] received 10 mg dydrogesterone QID [40mg daily] and group B [n=40] received 400 mg suppository vaginal progesterone [cyclogest] twice per day [800 mg daily]. Clinical pregnancy rate in cyclogest group was higher than dydrogesterone group but the difference was not significant [p=0.52], furthermore the miscarriage rate in two group was the same .The difference between two groups regarding antral follicle, embryo number, luteal-phase duration, endometrial thickness, oocyte number and metaphase-II was not significant [p>0.05]. The results showed that oral dydrogesterone is as effective as vaginal progesterone for luteal-phase support in women undergoing IVF