A case series of patients with endometrial insufficiency treated with pentoxifylline and alpha-tocopherol

TABLE

Patient 1a

1b 2a

2b 3

4a

4b

Figure 2.

CONCLUSIONS: Our data exploring biologically plausible genes suggest that pathogenic mechanisms underlying polyp formation are not uniform. Degree of PR expression relative to ERa /GPR-30 is emerging as a contributory mechanism for a subset of patients. Supported by: NIH 5K12 RR17672 (to LP); Reproductive Biology Center, AECOM (to LP).

5

6

7

P-276 A CASE SERIES OF PATIENTS WITH ENDOMETRIAL INSUFFICIENCY TREATED WITH PENTOXIFYLLINE AND ALPHATOCOPHEROL. A. A. Okusami, M. E. Moore, J. M. Hurwitz, S. S. Richlin, M. P. Leondires. Reproductive Medicine Associates of Connecticut, Norwalk, CT; Obstetrics & Gynecology, Stamford Hospital, Stamford, CT. OBJECTIVE: To determine the effect of pentoxifylline (PTX) and alphatocopherol (Vitamin E) on endometrial parameters in women with persistent thin and unfavorable uterine linings. DESIGN: Case series. MATERIALS AND METHODS: 8 patients (11 cycles) were identified with unfavorable endometrial lining by thickness %6 mm or echogenicity type R2 in late follicular phase. These parameters were unresponsive to high dose oral & vaginal estradiol (E2) therapy. Patients were treated with oral PTX 400 mg twice/day and vitamin E 400 IU twice/day with a goal of 6 months treatment. Outcome measures: endometrial thickness, echogenicity type and pregnancy. RESULTS: Table 1 summarizes our results.

S200

Abstracts

8

History

Uterine Treatment Lining lining (mm) Duration Thickness Pregnancy Pre-PTX/Vit E (months) (mm)/Type Outcome

5 type 2–3 34 y/o G1P0; Asherman’s 2 to retained products of conception (POC) Same 5 type 2

9

6.5 type 3 Spont preg; missed AB

Restarted 10 type 3 No preg for 1 2 5 type 1 Biochemical preg

37 y/o G1P1; 5 type 2 idiopathic endometrial insufficiency Same 5 type 2 6.5 type 2 39 y/o G1P1; Asherman’s  2 to postpartum hemorrhage 32 y/o G1P0; 5.5 type 2–3 acute & chronic endometritis, scarred endometrium on hysteroscopy 2 to retained POC. Gestational carrier recommended 34 y/o; retained 6 type 2 placenta after second delivery 34 y/o G0; 2–6 type 2–3 idiopathic endometrial insufficiency 39 y/o G0; 5.5 type 2 idiopathic endometrial insufficiency 2–6 type 1–3 39 y/o G3P2; fibroids, cervical stenosis, and Asherman’s 2 to hysteroscopic resection of fibroids 39 y/o G1P0; 4–8 type 2 unexplained infertility

4

6 type 2

FET; Live birth No preg but improved cavity

10

6.5 type 1–2

11

N/A

Spont preg; live birth

5

6 type 2

FET; live birth

2

N/A

Spont ongoing preg

5

5–6 type 2 Donor egg; no preg

4

5–7 type 2–3

8

6–8 type 2 Spont biochemical preg

No preg; multiple cycles

CONCLUSIONS: In our case series, PTX and Vitamin E were used for patients who failed to develop an adequate uterine lining. 64% (7/11) of cycles resulted in a pregnancy. The combination of PTX and Vitamin E has been reported to improve endometrial parameters in radiation induced and idiopathic endometrial insufficiency (Ledee-Bataille, Hum Reprod 2002; Letur-Konirsch, F&S 2002). It has been speculated by these authors that increased platelet flexibility & decreased aggregation improves blood flow to small capillaries in the endometrium. Our case series corroborates these findings. This regimen, with minimal risks, provides a potential avenue for endometrial insufficiency. Supported by: None.

Vol. 88, Suppl 1, September 2007