Abstract
Objective To examine whether luteal E2 is obligatory for obtaining an adequately developed endometrium.
Design Survey of women with premature ovarian failure (POF) in a prospective, controlled, randomized study.
Setting In vitro fertilization unit in a tertiary care university medical center.
Patients Fourteen amenorrheic women with POF, candidates for oocyte donation, were divided into two distinct groups with seven women in each subgroup.
Interventions Endometrial priming with a fixed dose of oral micronized E2, 4 mg/d for 14 days, was similarly performed in the study and the control groups. Progesterone replacement during the luteal phase was also identical in the two groups and was accomplished by IM P in oil, 50 mg/d for another 14 days. Only the control group continued to have the same E2 regimen during the luteal phase.
MAIN OUTCOME MEASURES AND
Results Follicular phase mean E2 levels as well as luteal phase mean P levels were similar in both groups. However, luteal E2 levels differed significantly between the study and the control groups (21 +/- 5 and 692 +/- 199 pg/mL, respectively; conversion factor to SI units, 3.671). Nevertheless, histologic evaluation of endometrial biopsies on days 21 and 26 were similar for both groups. Endometrial gland dating, using light microscopy in the study and the control groups, on day 21, was 19.1 +/- 0.8 and 18.4 +/- 0.5, respectively, and on day 26, 25.4 +/- 0.8 and 25.9 +/- 0.5, respectively. Dating of the stroma in the two biopsies was also similar in both groups. Moreover, transmission electron microscopy performed in two patients of the study group showed typical characteristics of a secretory endometrium.
Conclusions Luteal E2 depletion in the human does not seem to adversely affect the morphological developmental capacity of the endometrium. Our results suggest that E2 secretion by the corpus luteum in the human does not appear to be obligatory for the development of a normal secretory endometrium. The actual receptivity of the endometrium after such preparation needs to be evaluated.
estradiol depletion luteal phase endometrial development, luteal estradiol not required secretory endometrium, premature ovarian failure oocyte donation endometrial priming, progesterone only luteal phase endometrial biopsy dating, corpus luteum estradiol endometrial receptivity necessity, estrogen withdrawal luteal phase endometrial morphology, randomized controlled trial estradiol progesterone endometrial preparation, premature ovarian failure hormone replacement endometrial histology, Younis Laufer luteal estradiol endometrial development, transmission electron microscopy secretory endometrium estradiol depletion
PMID 8005273 8005273 DOI 10.1016/s0015-0282(16)56823-x 10.1016/s0015-0282(16)56823-x
Keywords
Adult, Amenorrhea/etiology, Biopsy, Endometrium/growth & Development/pathology, Estradiol/administration & Dosage/blood/pharmacology, Female, Humans, Luteal Phase, Microscopy, Electron, Primary Ovarian Insufficiency/complications/metabolism/physiopathology, Prospective Studies, Estradiol