Endometrial preparation for frozen-thawed embryo transfer with or without pretreatment with gonadotropin-releasing hormone agonist

Abstract

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. Design: Prospective randomized study. Setting: Private outpatient infertility clinic. Patient(s): Two hundred ninety-six women undergoing frozen-thawed embryo transfer. Intervention(s): In group 1 (146 patients), depot GnRH agonist was administered in the luteal phase; treatment with 17β-estradiol transdermal patches at steadily increasing dosage from 100 to 300 μg 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 μg; this was increased to 300 μg after 7 days. Main Outcome Measure(s): Pregnancy, abortion, implantation and cancellation rates. Result(s): 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%). Conclusion(s): 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.