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TITLE:

COMPARISON OF ESTRADIOL VALERATE AND 17Β-ESTRADIOL EFFICACY IN ART PROGRAMS WITH APPLICATION OF VITRIFIED EMBRYOS AT PATIENTS WITH PREVIOUS MULTIPLE IMPLANTATION FAILURES

AUTHORS:

Sulima A. N., Voronaya V. V., Davydova A. A., Rybalka A. N., Baskakov P. N., Rumyantceva Z. S.

ABSTRACT:

Aim. This article is devoted to the problem of multiple implantation failures of the thawed embryos and the endometrium preparation with the application of HRT, which include estrogen medicines. The variety of estrogen medicines and the lack of information about their comparative effectiveness in ART programs prompted us to conduct a study aimed at finding the most optimal and effective estrogen medicine. For comparative analysis, we selected the oral forms of EV and 17β–E due to their ease of use and dosing. Materials and methods. The objects of the study were different according to the chemical structure of the oral forms of estrogen-containing medicines (EV and 17β–E) for HRT. Both are used in the process of endometrium preparation for the transfer of thawed embryos in patients with previous repeated implantation failures. The subjects of the study were the levels of expression of α-ER and markers of proliferative activity of cells (Ki-67) in the endometrium, echographic characteristics of the endometrium, and the amount of serum estradiol in the blood and the effectiveness of thawed embryo transfer performed using different forms of estrogen. Results. Significant differences were revealed (p<0.001), when comparing the levels of α-ER expression in the endometrium and the marker of endometrium proliferative activity Ki-67 under the influence of various forms of estrogen in the study groups. Analysis of proliferative changes in the endometrium based on the ultrasound examination also revealed statistically significant differences in the study groups (p<0.001). The difference was likewise noted in its echostructure. The analysis of the influence of various estrogen medicines on estradiol serum levels did not reveal any significant differences in the estradiol blood level at patients of the analyzed groups in any days of MP (p>0,1). The statistical analysis revealed significant differences in the frequency of positive outcomes (clinical pregnancy) in the study groups (χ2 = 6,40, p = 0,041, the number of degrees of freedom df = 2) with the best indicators in Group 2. Conclusions. Based on the above provided data, it can be concluded that in the framework of hormone replacement therapy in the preparation of the endometrium for the thawed embryo transfer at patients with previous multiple implantation failures, it is preferable to use the oral form of 17β–E, as compared to the oral form of EV. Keywords: implantation failures, frozen embryo transfer protocols, hormone replacement therapy, 17β-estradiol, immunohistochemistry.

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