Endometrial Preparation and Luteal Support

To achieve optimum endometrial growth, exogenous estradiol 17 p (micro-nized) is started on the day of retrieval. The dosage is determined by endometrial thickness measured on the day of retrieval. If the endometrial thickness is less than 6 mm, then 12 mg a day is started; if the thickness is between 6 and 8 mm, then 10 mg a day is started and if the thickness is more than 8 mm, then 6 mg is used, all in three divided doses. Recently, we have begun administering the estradiol treatment even before oocyte collection, when an extremely thin endometrium (i.e., <4mm) is recorded on an ultrasound scan prior to the collection. We are currently investigating an alternative approach whereby the in vitro matured oocyte is vitrified when the endometrial lining is thin. The endometrium is then prepared in an artificial cycle and, once it reaches 8 mm, the oocytes are thawed, fertilized, and transferred. In an IVM treatment cycle, luteal support is started on the day that oocyte maturation is achieved and ICSI is performed, with daily intramuscular injections of progesterone in oil or Prometrium (Schering Canada) 200, tid. Estradiol and progesterone supplementation is continued until the 12th week of pregnancy (Fig. 1).

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