The use of vaginal ultrasound for monitoring endometrial preparation in a donor oocyte program.
OBJECTIVE
To determine whether vaginal sonographic measurements can be used to monitor the endometrial preparation of recipients in a donor egg program.


METHODS
Prospective clinical trial.


METHODS
University hospital-based IVF and donor egg program.


METHODS
Twelve women without ovarian function.


METHODS
[1] In a control cycle, patients received 4 or 8 mg of oral E2 and vaginal ultrasound (US) daily until endometrial thickness > or = 6 mm with a triple-line pattern (favorable endometrium) was seen. Progesterone (P) in oil, 100 mg/d, was then added. [2] An endometrial biopsy was performed on day 7 of P therapy. [3] In a treatment cycle, US monitoring of endometrial development during estrogen (E) administration was used; and ET was performed on the 3rd day of P therapy.


RESULTS
In the control cycle, 8 mg/d or 4 mg/d of micronized E2 resulted in favorable endometrium development in all patients in a mean time of 5 and 7 days, respectively. After P treatment, only 1 of 12 endometrial biopsies was in phase. In the treatment cycles, the overall clinical pregnancy rate (PR) was 42%. In those patients with a favorable endometrium in the E replacement phase, before addition of P, the PR was 62.5%. All of the pregnant patients but only 42.8% of the nonpregnant patients had a favorable endometrium on US before the addition of P.


CONCLUSIONS
An endometrium that is favorable for implantation can result from the use of a simple fixed dose of E2, with higher doses achieving favorable endometrial development in shorter time. Vaginal sonography of endometrial development before P administration is more accurate than endometrial biopsy in predicting a successful donor egg cycle. Endometrial preparation in donor oocyte programs can be simplified by the use of vaginal US monitoring.
Shapiro
H
H
Department of Obstetrics and Gynecology, University of Toronto, Ontario, Canada.
Cowell
C
C
Casper
R F
RF
D004717:Endometrium / Q000000981:diagnostic imaging*; D004958:Estradiol / Q000627:therapeutic use; D005260:Female; D005307:Fertilization in Vitro; D006801:Humans; D007247:Infertility, Female; D008991:Monitoring, Physiologic / Q000379:methods; D009865:Oocytes; D011247:Pregnancy; D011374:Progesterone / Q000627:therapeutic use; D011446:Prospective Studies; D014019:Tissue Donors; D014463:Ultrasonography; D014621:Vagina
D011374:Progesterone; D004958:Estradiol