SUPEROVULATION CYCLE. A NEW WAY TO HAVE BETTER ENDOMETRIAL RESPONSE DURING ERA AND EMBRYO TRANSFER CYCLES: A CASE SERIES

Problem statement: Many patients benefit from a Superovulation regime, specifically in those cases where an optimal endometrial thickness is challenging to achieve with a standard medicated or natural frozen embryo transfer cycles. To study the safety and effectiveness of a new preparation method to improve endometrial response in patients with a thin endometrium (≤6mm). Proof of concept and validation study.

Methods: A cohort of 14 patients with thin endometrium were treated with follicle stimulating hormone (FSH) or Menotropin (HMG) in low doses during the first phase of their cycle. Once at least 1 follicle of 17-18mm has been achieved and endometrial thickness (ET) was >7mm, triggering with human chorionic gonadotrophin (hCG) was performed. Ovulation was confirmed prior to starting progesterone (P4) support. For all patients, an endometrial biopsy for the Endometrial Receptivity Analysis (ERA) test was performed on day hCG+7 (Pipelle® CCD, France) as per the clinic’s standard protocol for a modified natural cycle.

Embryo transfer (ET) was performed according to the ERA result. The same endometrial preparation (including drug doses) was replicated between the ERA and ET cycles for all patients.

Results: The 14 patients included in this study had a mean age of 38.21 + 2.83 years, and a BMI of 23.05 + 2.88. The mean number of previous failed cycles within this patient cohort was 1.77 + 1.73, with an endometrial thickness of 9.24 + 1.28 mm.

After single euploid embryo transfers (sEET) in all patients, the outcomes obtained were as following: Pregnancy Rate 78.57% (11/14), and Live birth rate 63.64% (7/11).

Conclusion: Low doses of gonadotrophins can be used in ERA and embryo transfer cycles when patients present with poor endometrial response to oestradiol and a thin endometrium. Obtaining a thicker endometrium, allowing for an endometrial biopsy to be performed, and successful clinical outcomes demonstrate the safety and effectiveness of the described, novel methodology.