A case series of patients with endometrial insufficiency treated with pentoxifylline and alpha-tocopherol

Abstract

To determine the effect of pentoxifylline (PTX) and alpha-tocopherol (Vitamin E) on endometrial parameters in women with persistent thin and unfavorable uterine linings. Case series. 8 patients (11 cycles) were identified with unfavorable endometrial lining by thickness ≤6 mm or echogenicity type ≥2 in late follicular phase. These parameters were unresponsive to high dose oral & vaginal estradiol (E2) therapy. Patients were treated with oral PTX 400 mg twice/day and vitamin E 400 IU twice/day with a goal of 6 months treatment. Outcome measures: endometrial thickness, echogenicity type and pregnancy. Table 1 summarizes our results. Tabled 1Table.PatientHistoryUterine lining (mm) Pre-PTX/Vit ETreatment Duration (months)Lining Thickness (mm)/TypePregnancy Outcome1a34 y/o G1P0; Asherman's 2° to retained products of conception (POC)5 type 2–396.5 type 3Spont preg; missed AB1bSame5 type 2Restarted for 110 type 3No preg2a37 y/o G1P1; idiopathic endometrial insufficiency5 type 225 type 1Biochemical preg2bSame5 type 246 type 2FET; Live birth339 y/o G1P1; Asherman's 2° to post-partum hemorrhage6.5 type 2106.5 type 1–2No preg but improved cavity4a32 y/o G1P0; acute & chronic endometritis, scarred endometrium on hysteroscopy 2° to retained POC. Gestational carrier recommended5.5 type 2–311N/ASpont preg; live birth4b34 y/o; retained placenta after second delivery6 type 256 type 2FET; live birth534 y/o G0; idiopathic endometrial insufficiency2–6 type 2–32N/ASpont ongoing preg639 y/o G0; idiopathic endometrial insufficiency5.5 type 255–6 type 2Donor egg; no preg739 y/o G3P2; fibroids, cervical stenosis, and Asherman's 2° to hysteroscopic resection of fibroids2–6 type 1–345–7 type 2–3No preg; multiple cycles839 y/o G1P0; unexplained infertility4–8 type 286–8 type 2Spont biochemical preg Open table in a new tab In our case series, PTX and Vitamin E were used for patients who failed to develop an adequate uterine lining. 64% (7/11) of cycles resulted in a pregnancy. The combination of PTX and Vitamin E has been reported to improve endometrial parameters in radiation induced and idiopathic endometrial insufficiency (Ledee-Bataille, Hum Reprod 2002; Letur-Konirsch, F&S 2002). It has been speculated by these authors that increased platelet flexibility & decreased aggregation improves blood flow to small capillaries in the endometrium. Our case series corroborates these findings. This regimen, with minimal risks, provides a potential avenue for endometrial insufficiency.