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.