Endometrial preparation for frozen-thawed embryo transfer with or without pretreatment with gonadotropin-releasing hormone agonist.
OBJECTIVE
To test the efficacy of endometrial preparation with exogenous steroids, without pretreatment with gonadotropin-releasing hormone (GnRH) agonist, in women with normal ovarian function.


METHODS
Prospective randomized study.


METHODS
Private outpatient infertility clinic.


METHODS
Two hundred ninety-six women undergoing frozen-thawed embryo transfer.


METHODS
In group 1 (146 patients), depot GnRH agonist was administered in the luteal phase; treatment with 17beta-estradiol transdermal patches at steadily increasing dosage from 100 to 300 microg was then given for at least 12 days. In group 2 (150 patients), endometrial preparation began on day 1 of menstrual cycle. The starting dose was 200 microg; this was increased to 300 microg after 7 days.


METHODS
Pregnancy, abortion, implantation and cancellation rates.


RESULTS
In group 2, six cycles (4%) were cancelled due to evidence of ovulation. Groups were similar in the percentage of embryos that survived freezing-thawing (77.1% in group 1 and 76.6% in group 2) and in the number of embryos transferred per patient (2.1 +/- 0.6 and 2.1 +/- 0.7, respectively). Groups 1 and 2 did not differ significantly in rates of pregnancy (19.7% and 24.1%), abortion (17.8% and 11.7%), and implantation (10.4% and 11.9%).


CONCLUSIONS
Endometrial preparation for frozen-thawed embryo transfer based exclusively on steroid administration appears to be as effective as the more conventional protocol involving preliminary desensitization with a GnRH agonist. This simplified protocol reduces costs, minimizes pharmacologic treatment, and increases patient compliance.
Dal Prato
Luca
L
Tecnobios Procreazione, Center for Reproductive Health, Bologna, Italy. dalprato@technobios.it
Borini
Andrea
A
Cattoli
Monica
M
Bonu
Maria Antonietta
MA
Sciajno
Raffaella
R
Flamigni
Carlo
C
D000022:Abortion, Spontaneous / Q000453:epidemiology; D000328:Adult; D015925:Cryopreservation; D010064:Embryo Implantation; D004624:Embryo Transfer; D004622:Embryo, Mammalian; D004958:Estradiol / Q000627:therapeutic use*; D005260:Female; D005300:Fertility Agents, Female / Q000819:agonists; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists; D006801:Humans; D015994:Incidence; D011247:Pregnancy; D018873:Pregnancy Rate
D005300:Fertility Agents, Female; D007987:Gonadotropin-Releasing Hormone; D004958:Estradiol