204 PREGNANCY OUTCOME IN WOMEN WITH LUTEAL DEFECTIVE CYCLES FOLLOWING TREATMENT WITH PREDNISOLONE, PROGESTERONE AND INTRACYTOPLASMIC SPERM INJECTION

Abstract

Inadequate secretory transformation of the endometrium may result in luteal defective cycles (LDC) and recurrent abortions. The goal of the study was to evaluate application of progesterone (P4), prednisolone (PR) and intracytoplasmic sperm injection (ICSI) in women with LDC. Patients were divided into control (n = 36, without LDC), mild (n = 39) and marked (n = 45) LDC groups. The P4 concentration was assayed in blood on cycle Day 21 and patients with >20 ng mL^–1 of P4 were considered controls, whereas patients with <10 ng mL^–1 of P4 and <3 ng mL^–1 of P4 were considered to be in the mild and marked LDC groups, respectively. The patients received 5 mg of PR daily, except for the control group, at the time of human menopausal gonadotropin and human chorionic gonadotropin treatments. The P4, oestradiol (E2), prolactin (PRL), testosterone (T), FSH and LH were measured in the follicular fluid (FF) at the time of oocyte aspiration. Within 24 h after embryo transfer, all patients received 400 mg vaginal P4 and 10 mg oral P4 twice daily. If the beta-hCG test was positive at 2 weeks following embryo transfer, the treatment was continued for 12 to 14 wk. ANOVA was used with the t-test and chi-square test for statistical analysis of the data. The concentration of E2 in the FF was lower (P < 0.01) in the mild (512 ng mL^–1) and marked (340 ng mL^–1) LDC groups vs the control group (720 ng mL^–1). The concentration of P4 was lower (P < 0.01) in the control (11 854 ng mL^–1) vs the mild (16 486 ng mL^–1) and marked (27 642 ng mL^–1) LDC groups. The FSH (2.3 IU L^–1) and LH (0.08 IU mL^–1) concentrations were lower (P < 0.01) in the control vs the LDC groups (FSH: 4.6 IU L^–1, 6.5 IU L^–1; and LH: 0.13 IU L^–1, 1.17 IU L^–1 in the mild and marked LDC groups, respectively). The PRL (21 ng mL^–1 in mild and 32.8 ng mL^–1 in marked) and T (3.24 ng mL^–1 in mild and 6.8 ng mL^–1 in marked) concentrations were higher (P < 0.01) in LDC groups compared to the control (PRL: 6 ng mL^–1; and T: 1.2 ng mL^–1) group. The cancellation rates (poor responder patients were not involved in the ICSI cycles) were 7.1% in the mild, 16.6% in the marked LDC groups and 0% in the control group. The percentages of fertilized oocytes by ICSI were higher in the control (84.1%; P < 0.05) vs mild (73%) and marked (69%) LDC groups. The embryos were transferred at 4-cell to 8-cell stages. The number of transferred embryos per patient was 3 in all groups. The pregnancy rate per embryo transfer was significantly different (P < 0.05) in the control group (45.4%) vs marked LDC group (31.8%), but was similar to the mild LDC group (40.2%). In conclusion, with the clinical application of PR at the time of stimulation, ICSI and P4 during transfer and early gestation, pregnancy rates for women with LDC are not similar to those for normal women except in the mild LDC group.

The authors thank the University of Baghdad, Medical School, Baghdad Teaching Hospital, Ministry of Health and Ministry of Higher Education and Scientific Research for their kind financial support and cooperation.