A thickened endometrial stripe on day 3 of leuprolide acetate down-regulated IVF cycles is associated with reduced clinical pregnancy and live birth rates

Abstract

OBJECTIVE: The clinical significance of a thickened endometrial stripe (ES) on day of ovarian stimulation following midluteal GnRH down-regulation has yet been reported. The objective is to compare the IVF outcomes in women who began ovarian stimulation with a thickened ES to those who delayed their start for 3-4 days until their endometrium has shed. DESIGN: Retrospective study. MATERIALS AND METHODS: Patients who underwent midluteal-initiated LA down-regulation for IVF between 1/1/2004-12/31/2009 were identified. Patients with thickened ES (5mm or greater) on cycle day 3 were included. Patients with estradiol >75pg/ml or progesterone >1ng/ml were excluded. COH with FSH and hMG was performed in a standard step-down protocol. HCG was administered when there were at least 2 follicles >17 mm and retrieval was performed 35 hours later. The main outcome measures were clinical pregnancy and live birth rates. Other outcomes included: ampules of gonadotropin required, number of days of ovarian stimulation, peak estrogen level, cancellation rate, number s of oocytes retrieved and and embryos transferred. Statistical analyses included χ2 test and Mann-Whitney test. P<0.05 was deemed statistically significant. RESULTS: 636 IVF cycles had an initial ES of 5mm or greater. 514 cycles started COH on day 3; 122 cycles were delayed for 3-4 days on LA before starting COH. There were no significant differences between the two groups in terms of age, previous IVF cycles, baseline FSH, LH and estradiol levels, days of stimulation, total ampules of gonadotropins, number of oocytes retrieved, and number of embryos transferred. Compared to cycles that started COH on day 3, cycles that were delayed for 3-4 days had significantly higher clinical pregnancy (49.1% vs. 37.4%) and live birth (38.5% vs. 22.4%) rates. CONCLUSION: In patients with thickened ES on baseline scan following LA down-regulation, delaying COH for 3-4 days results in higher clinical pregnancy and live birth rates.