The Use of Vaginal Ultrasound for Monitoring Endometrial Preparation in a Donor Oocyte Program

Objective: To determine whether vaginal sonographic measurements can be used to monitor the endometrial preparation of recipients in a donor egg program.

Design: Prospective clinical trial.

Setting: University hospital-based IVF and donor egg program.

Patients: Twelve women without ovarian function.

Interventions: [1] In a control cycle, patients received 4 or 8 mg of oral E2 and vaginal ultrasound (US) daily until endometrial thickness > or = 6 mm with a triple-line pattern (favorable endometrium) was seen. Progesterone (P) in oil, 100 mg/d, was then added. [2] An endometrial biopsy was performed on day 7 of P therapy. [3] In a treatment cycle, US monitoring of endometrial development during estrogen (E) administration was used; and ET was performed on the 3rd day of P therapy.

Results: In the control cycle, 8 mg/d or 4 mg/d of micronized E2 resulted in favorable endometrium development in all patients in a mean time of 5 and 7 days, respectively. After P treatment, only 1 of 12 endometrial biopsies was in phase. In the treatment cycles, the overall clinical pregnancy rate (PR) was 42%. In those patients with a favorable endometrium in the E replacement phase, before addition of P, the PR was 62.5%. All of the pregnant patients but only 42.8% of the nonpregnant patients had a favorable endometrium on US before the addition of P.

Conclusion: An endometrium that is favorable for implantation can result from the use of a simple fixed dose of E2, with higher doses achieving favorable endometrial development in shorter time. Vaginal sonography of endometrial development before P administration is more accurate than endometrial biopsy in predicting a successful donor egg cycle. Endometrial preparation in donor oocyte programs can be simplified by the use of vaginal US monitoring.