Controlled preparation of the endometrium with exogenous estradiol and progesterone in women having functioning ovaries

Abstract

Objective To determine if controlled preparation of the endometrium with exogenous estradiol (E 2 ) and progesterone (P) could be achieved in women retaining their ovarian function without requiring prior oavarian suppression with a long-acting agonist of gonadotropin-releasing hormone (GnRH-a). Design Prospective feasibility study of a new simplified hormone regimen for preparation of endometrium receptivity. Six volunteer women received transdermal E 2 and vaginal P without prior suppression of their ovarian function with GnRH-a. The control group consisted of previously reported cases receiving GnRH-a and E 2 and P. Setting Academic tertiary care institution. Patients Six volunteer women. Main Outcome Measures Participants received transdermal E 2 and P after a regimen designed to duplicate the plasma E 2 and P levels seen in the menstrual cycle. Intervention: Endometrial biopsy. Results Plasma luteinizing hormone increased to surge levels in one woman on day 11, in two on day 12, and on day 14 in the remaining three women. No follicular growth was noticed on ultrasound, and no increase in plasma P occurred before the onset of P administration on day 15. Day 20 endometrium specimens showed early secretory changes as previously reported in women deprived of ovarian function receiving similar hormonal treatment. Conclusions Our results indicate that controlled preparation of the endometrium can be achieved with exogenous E 2 and P without prior ovarian suppression with a GnRH-a in women having functioning ovaries. Hence, administration of exogenous E 2 and P appears to be a viable simpler alternative to the combined administration of GnRH-a and exogenous E 2 and P, which avoids the side effects and the cost of GnRH-a.