The Endometrial Receptivity Test: The Impact of Combined Treatment with Pentoxifylline and Alpha-Tocopherol in Patients with Recurrent Implantation Failure or Recurrent Pregnancy Loss

Abstract

Background/Objectives: The management of patients with recurrent implantation failure (RIF) or recurrent pregnancy loss (RPL) is a real challenge. Studying endometrial proliferation and vascularization by ultrasound during the embryo implantation window is an option for investigating these failures. This approach involves measuring the endometrial volume, the uterine arteries pulsatility index (PI), and the sub-endometrial flow index (VFI). Methods: The aim of our single-center retrospective study was to evaluate the benefit of treatment with pentoxifylline (400 mg twice daily) and alpha-tocopherol (500 IU twice daily), which was administered for at least 3 months. This study included 52 patients presenting abnormal ultrasound criteria, i.e., endometrial volume less than 2 cm³ and/or PI greater than 2.8 and/or VFI less than 0.25. Results: After treatment, we observed a significant increase in endometrial volume of 0.32 cm³ (p = 0.0054), as well as a significant increase in VFI of 0.49 (p = 0.041) in comparison to the control group. After treatment, the PI of the right uterine artery decreased significantly by 0.25 (p = 0.029) and the PI of the left uterine artery decreased by 0.27, but not significantly. In addition, our study showed that the clinical pregnancy rate (CPR) was more improved in the treated group compared to controls. Conclusions: Our study showed a promising benefit of pentoxifylline and alpha-tocopherol on endometrial properties; this needs to be corroborated by a larger prospective study.

Keywords: implantation/miscarriages; pentoxifylline; tocopherol.

Figure 1

Study sampling: inclusion and exclusion criteria.

Figure 2

Study timeline. EV = Endometrial Volume; PI = pulsatility of the uterine arteries; VFI = vascularization flow index.