Importance of the biopsy date in autologous endometrial cocultures for patients with multiple implantation failures.

OBJECTIVE

To analyze the effectiveness of autologous endometrial coculture by the cycle day of the endometrial biopsy.

DESIGN

Retrospective study.

SETTING

University-based IVF center.

PATIENT(S): Two hundred eight patients with multiple IVF failures.

INTERVENTION(S): Embryos were split and randomly allocated to growth on autologous endometrial coculture or conventional media.

MAIN OUTCOME MEASURE(S): Embryo quality and pregnancy outcome.

RESULT(S): The overall clinical pregnancy rate was 41.8%. Embryos grown on autologous endometrial coculture were of higher quality (more blastomeres and less fragmentation) than embryos grown with conventional media. Early luteal biopsies (<5 days after LH surge) for autologous endometrial coculture did not demonstrate an improvement in embryo quality as compared to the significant improvement demonstrated with later luteal endometrial biopsies (> or =5 days after LH surge). The date of the biopsy was predictive of pregnancy outcome when using autologous endometrial coculture (44.7% [> or =5 days after LH surge] vs. 18.8% [<5 days after LH surge], P=.012).

CONCLUSION(S): We have demonstrated an improvement in embryo quality when using autologous endometrial coculture. The improvement in embryo quality and higher pregnancy rates were limited to biopsies > or =5 days after the LH surge. This suggests that mid/late luteal phase endometrium contains factors that enhanced embryo growth and subsequent implantation.