A SECOND CASE OF SUCCESSFUL CONCEPTION IN A NATURAL CYCLE DESPITE A MAXIMUM ENDOMETRIAL THICKNESS IN THE LATE FOLLICULAR PHASE OF 4MM
AACE ePoster Library. Check D. 05/13/15; 97804; 913
Diane Check
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Abstract
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Objective: To determine if a successful conception can occur again in a natural cycle despite a maximum endometrial thickness in the late luteal phase of only 4mm (since there is only one case report in the literature where this fete was achieved).
Methods: A 31 year old woman who had failed to conceive after 4 months sought help in getting pregnant. She was evaluated with serial pelvic sonography and serial hormonal levels for estradiol, progesterone, and LH. Endometrial thickness was also measured throughout the follicular phase until oocyte release.
Results: In two cycles of evaluating follicular maturation she was found to have a long follicular phase, but she did attain a mature follicle both times (average diameter follicle >18mm and a serum estradiol >200 pg/mL). Oocyte release was also documented as was a normal post-coital test. In both cycles her early follicular phase endometrial thickness was 2mm and only reached a peak of 4mm in the late follicular phase. In the cycle of conception she reached a dominant follicle of 19.3mm average diameter on day 23, a serum estradiol of 376 pg/mL, a progesterone level of 1 ng/mL and an LH surge of 37 mIU/mL (was 7 mIU/mL on day 21). Her peak endometrial thickness was 4mm. She was treated with vaginal progesterone, and conceived in her second cycle. She delivered a healthy baby at 38 ½ weeks.
Discussion: There is only one documented case report in the literature describing a successful pregnancy in a natural cycle with a maximum endometrial thickness of 4mm. Similarly there are very few successful reports of pregnancies with a 4mm maximum endometrial thickness in cycles of in vitro fertilization-embryo transfer (IVF-ET). Thus most reproductive endocrinologists faced with this circumstance would have advised IVF-ET with transfer of the embryos to a gestational carrier. This suggestion could cost as much as $100.000.
Conclusions: The reporting of a second case of a successful pregnancy in a natural cycle makes it less likely that the first case was merely a miracle. The treating physician should seek other causes of infertility (in this case a luteal phase defect) and correct these infertility factors and give the woman a fair chance of conceiving before recommending such an expensive option as a gestational carrier.
Methods: A 31 year old woman who had failed to conceive after 4 months sought help in getting pregnant. She was evaluated with serial pelvic sonography and serial hormonal levels for estradiol, progesterone, and LH. Endometrial thickness was also measured throughout the follicular phase until oocyte release.
Results: In two cycles of evaluating follicular maturation she was found to have a long follicular phase, but she did attain a mature follicle both times (average diameter follicle >18mm and a serum estradiol >200 pg/mL). Oocyte release was also documented as was a normal post-coital test. In both cycles her early follicular phase endometrial thickness was 2mm and only reached a peak of 4mm in the late follicular phase. In the cycle of conception she reached a dominant follicle of 19.3mm average diameter on day 23, a serum estradiol of 376 pg/mL, a progesterone level of 1 ng/mL and an LH surge of 37 mIU/mL (was 7 mIU/mL on day 21). Her peak endometrial thickness was 4mm. She was treated with vaginal progesterone, and conceived in her second cycle. She delivered a healthy baby at 38 ½ weeks.
Discussion: There is only one documented case report in the literature describing a successful pregnancy in a natural cycle with a maximum endometrial thickness of 4mm. Similarly there are very few successful reports of pregnancies with a 4mm maximum endometrial thickness in cycles of in vitro fertilization-embryo transfer (IVF-ET). Thus most reproductive endocrinologists faced with this circumstance would have advised IVF-ET with transfer of the embryos to a gestational carrier. This suggestion could cost as much as $100.000.
Conclusions: The reporting of a second case of a successful pregnancy in a natural cycle makes it less likely that the first case was merely a miracle. The treating physician should seek other causes of infertility (in this case a luteal phase defect) and correct these infertility factors and give the woman a fair chance of conceiving before recommending such an expensive option as a gestational carrier.
Objective: To determine if a successful conception can occur again in a natural cycle despite a maximum endometrial thickness in the late luteal phase of only 4mm (since there is only one case report in the literature where this fete was achieved).
Methods: A 31 year old woman who had failed to conceive after 4 months sought help in getting pregnant. She was evaluated with serial pelvic sonography and serial hormonal levels for estradiol, progesterone, and LH. Endometrial thickness was also measured throughout the follicular phase until oocyte release.
Results: In two cycles of evaluating follicular maturation she was found to have a long follicular phase, but she did attain a mature follicle both times (average diameter follicle >18mm and a serum estradiol >200 pg/mL). Oocyte release was also documented as was a normal post-coital test. In both cycles her early follicular phase endometrial thickness was 2mm and only reached a peak of 4mm in the late follicular phase. In the cycle of conception she reached a dominant follicle of 19.3mm average diameter on day 23, a serum estradiol of 376 pg/mL, a progesterone level of 1 ng/mL and an LH surge of 37 mIU/mL (was 7 mIU/mL on day 21). Her peak endometrial thickness was 4mm. She was treated with vaginal progesterone, and conceived in her second cycle. She delivered a healthy baby at 38 ½ weeks.
Discussion: There is only one documented case report in the literature describing a successful pregnancy in a natural cycle with a maximum endometrial thickness of 4mm. Similarly there are very few successful reports of pregnancies with a 4mm maximum endometrial thickness in cycles of in vitro fertilization-embryo transfer (IVF-ET). Thus most reproductive endocrinologists faced with this circumstance would have advised IVF-ET with transfer of the embryos to a gestational carrier. This suggestion could cost as much as $100.000.
Conclusions: The reporting of a second case of a successful pregnancy in a natural cycle makes it less likely that the first case was merely a miracle. The treating physician should seek other causes of infertility (in this case a luteal phase defect) and correct these infertility factors and give the woman a fair chance of conceiving before recommending such an expensive option as a gestational carrier.
Methods: A 31 year old woman who had failed to conceive after 4 months sought help in getting pregnant. She was evaluated with serial pelvic sonography and serial hormonal levels for estradiol, progesterone, and LH. Endometrial thickness was also measured throughout the follicular phase until oocyte release.
Results: In two cycles of evaluating follicular maturation she was found to have a long follicular phase, but she did attain a mature follicle both times (average diameter follicle >18mm and a serum estradiol >200 pg/mL). Oocyte release was also documented as was a normal post-coital test. In both cycles her early follicular phase endometrial thickness was 2mm and only reached a peak of 4mm in the late follicular phase. In the cycle of conception she reached a dominant follicle of 19.3mm average diameter on day 23, a serum estradiol of 376 pg/mL, a progesterone level of 1 ng/mL and an LH surge of 37 mIU/mL (was 7 mIU/mL on day 21). Her peak endometrial thickness was 4mm. She was treated with vaginal progesterone, and conceived in her second cycle. She delivered a healthy baby at 38 ½ weeks.
Discussion: There is only one documented case report in the literature describing a successful pregnancy in a natural cycle with a maximum endometrial thickness of 4mm. Similarly there are very few successful reports of pregnancies with a 4mm maximum endometrial thickness in cycles of in vitro fertilization-embryo transfer (IVF-ET). Thus most reproductive endocrinologists faced with this circumstance would have advised IVF-ET with transfer of the embryos to a gestational carrier. This suggestion could cost as much as $100.000.
Conclusions: The reporting of a second case of a successful pregnancy in a natural cycle makes it less likely that the first case was merely a miracle. The treating physician should seek other causes of infertility (in this case a luteal phase defect) and correct these infertility factors and give the woman a fair chance of conceiving before recommending such an expensive option as a gestational carrier.
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