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The effect of follicular phase length on cycle outcomes and endometrial development in gonadotrophin ovarian stimulation/intrauterine insemination cycles

Published:December 17, 2019DOI:https://doi.org/10.1016/j.rbmo.2019.12.007

      Abstract

      Research question

      Does a shorter follicular phase length (FPL) affect cycle outcomes and endometrial development among women undergoing gonadotrophin ovarian stimulation/intrauterine insemination (OS/IUI)?

      Design

      Retrospective cohort study of 4773 OS/IUI cycles among 2054 patients. FPL was analysed first continuously, then dichotomously using an arbitrary cut-off at the 15th percentile (8 days) to divide cycles into shorter and longer FPL groups. Receiver operating characteristic (ROC) curves were constructed to further analyse the impact of FPL on all outcomes. Primary outcomes included clinical pregnancy, spontaneous abortion, multiple pregnancy and non-viable (ectopic/biochemical) pregnancy rates (CPR, SABR, MPR and NVPR, respectively). Secondary outcomes included endometrial thickness. All analyses controlled for age, day 3 FSH and body mass index.

      Results

      When analysing FPL continuously, CPR increased by 6.0% (adjusted odds ratio [aOR] 1.06, 95% CI 1.03–1.09, P < 0.001) with each additional follicular phase day. Similarly, in the dichotomous analysis, cycles with a longer FPL resulted in higher CPR with 45% higher odds of clinical pregnancy (aOR 1.45, 95% CI 1.07–1.97, P = 0.018). No effect of FPL was noted on NVPR, SABR or MPR. Endometrial thickness increased by 0.09 mm (95% CI 0.06–0.12, P < 0.001) with each additional FPL day and was increased in the longer compared with the shorter FPL group (adjusted mean difference 1.08 mm, 95% CI 0.81–1.34, P < 0.001).

      Conclusions

      The data suggest that in gonadotrophin OS/IUI cycles, FPL might impact both chance of clinical pregnancy and endometrial thickness, independent of maternal age and ovarian reserve.

      Keywords

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      Biography

      Jennifer Bakkensen received her BS from the University of North Carolina at Chapel Hill and MD from Weill Cornell Medical College. She is a resident in the Brigham and Women’s and Massachusetts General Hospital Residency in Obstetrics and Gynecology and plans to pursue a fellowship in Reproductive Endocrinology and Infertility.
      Key message
      This large-scale retrospective study suggests a possible relationship, independent of age and ovarian reserve, between follicular phase length, endometrial thickness and clinical pregnancy rates, specifically among women undergoing gonadotrophin-induced OS/IUI, an important first-line infertility treatment. These findings may help physicians in counselling their patients on the likelihood of successful OS/IUI treatment.