Combined treatment by pentoxifylline and tocopherol for recipient women with a thin endometrium enrolled in an oocyte donation program

Abstract

Objective: Ultrasound assessment of the endometrium has become a standard procedure during the diagnostic work-up and treatment of infertility. The clinical differences in endometrial thickness remain controversial and clinicians have not been able to establish an ideal thickness for conception. However, the concept that some minimum thickness is required to establish a clinical pregnancy is widely accepted and thin endometrium, unresponsive to intensive estrogen therapy, is associated with a poor outcome in ART. A combination of pentoxifylline (PTX) and tocopherol (Vit. E) has been reported to be an effective treatment of musculocutaneous radiation-induced fibrosis, both in an experimental model and in humans. We therefore hypothesized that any thin uterine endometrium, even when the causative agent is unknown, can be treated like iatrogenically induced fibroDesign: We tested this treatment in 18 oocyte recipients whose endometrium remained thin in the late proliferative phase, despite vaginal treatment with micronized estradiol started the first day of the cycle observed. All patients received the combination of PTX and Vit. E for six months. We then evaluated the effect on endometrial thickness and the pregnancy and delivery rates.Materials/Methods: The inclusion criteria were designed to enroll oocytes recipients (n = 18) who failed to develop a preovulatory endometrial thickness of at least 6 mm after receiving vaginal micronized estradiol. The eighteen patients received a combination of PTX (800 mg/d) and Vit. E (1000 IU/d) for six months. The main outcome measurements were the change in endometrial thickness and the pregnancy and delivery rates after treatment.Results: Endometrial thickness (ETh) increased significantly (p <0.001): the mean Eth was 4.9 +/− 0.6 mm before and 6.2 +/−1.4 mm after treatment, with 72% (13/18) good responders. Five patients did not respond to the treatment. Three patients, among two after previous radiotherapy, were spontaneously pregnant, and two were pregnant after embryo transfer. Three patients did not have embryo transfer. The pregnancy rate was thus 33% and the delivery rate 27%Conclusions: Treatment by PTX and Vit. E together appears to improve the pregnancy rate in patients with a thin endometrium by increasing the endometrial thickness and improving ovarian function especially after total body irradiationSupported by: Fondation fertilité stérilité et l’INSERM. Objective: Ultrasound assessment of the endometrium has become a standard procedure during the diagnostic work-up and treatment of infertility. The clinical differences in endometrial thickness remain controversial and clinicians have not been able to establish an ideal thickness for conception. However, the concept that some minimum thickness is required to establish a clinical pregnancy is widely accepted and thin endometrium, unresponsive to intensive estrogen therapy, is associated with a poor outcome in ART. A combination of pentoxifylline (PTX) and tocopherol (Vit. E) has been reported to be an effective treatment of musculocutaneous radiation-induced fibrosis, both in an experimental model and in humans. We therefore hypothesized that any thin uterine endometrium, even when the causative agent is unknown, can be treated like iatrogenically induced fibro Design: We tested this treatment in 18 oocyte recipients whose endometrium remained thin in the late proliferative phase, despite vaginal treatment with micronized estradiol started the first day of the cycle observed. All patients received the combination of PTX and Vit. E for six months. We then evaluated the effect on endometrial thickness and the pregnancy and delivery rates. Materials/Methods: The inclusion criteria were designed to enroll oocytes recipients (n = 18) who failed to develop a preovulatory endometrial thickness of at least 6 mm after receiving vaginal micronized estradiol. The eighteen patients received a combination of PTX (800 mg/d) and Vit. E (1000 IU/d) for six months. The main outcome measurements were the change in endometrial thickness and the pregnancy and delivery rates after treatment. Results: Endometrial thickness (ETh) increased significantly (p <0.001): the mean Eth was 4.9 +/− 0.6 mm before and 6.2 +/−1.4 mm after treatment, with 72% (13/18) good responders. Five patients did not respond to the treatment. Three patients, among two after previous radiotherapy, were spontaneously pregnant, and two were pregnant after embryo transfer. Three patients did not have embryo transfer. The pregnancy rate was thus 33% and the delivery rate 27% Conclusions: Treatment by PTX and Vit. E together appears to improve the pregnancy rate in patients with a thin endometrium by increasing the endometrial thickness and improving ovarian function especially after total body irradiation Supported by: Fondation fertilité stérilité et l’INSERM.