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Reproductive Endocrinology · Luteal Phase

The effect of estradiol depletion during the luteal phase on endometrial development

Younis JS, Ezra Y, Sherman Y, Simon A, Schenker JG, Laufer N

Published July 1994 Fertility and Sterility, 62(1), 103-107
DOI 10.1016/s0015-0282(16)56823-x PMID 8005273

RRM Academy Synopsis

Luteal estradiol seems unneeded for the endometrium in ovarian failure

A randomized study of 14 women with premature ovarian failure found that luteal estradiol appears unneeded for normal endometrial structure on biopsy. Endometrial biopsies looked similar with or without luteal-phase estradiol. Seven women stopped estradiol after 14 days and seven continued it. Both groups received progesterone.

Key Findings

  • Fourteen women with premature ovarian failure were randomized, seven per group. Both groups received estradiol for 14 days, then progesterone for 14 days; only the control group also kept estradiol.
  • Luteal-phase estradiol levels differed significantly between the two groups, while follicular-phase estradiol and luteal-phase progesterone levels were similar.
  • Endometrial biopsies on days 21 and 26 were similar in both groups. Gland dating on day 21 was 19.1 (study) and 18.4 (control); on day 26 it was 25.4 and 25.9.
  • Stromal dating was similar in both groups. Transmission electron microscopy in two study-group women showed typical features of a secretory endometrium.
  • Midluteal biopsies showed a lag in endometrial maturation of 2 to 3 days, similar in both groups. Late luteal biopsies were in phase.

Interpretation

This is a small randomized comparison with seven women in each group. The women had premature ovarian failure and were candidates for oocyte donation. Three had a chromosomal difference (Turner mosaic or Swyer syndrome). The trial gave hormone replacement and judged the endometrium under a microscope on days 21 and 26. Implantation and pregnancy were not outcomes. The authors state that endometrial receptivity after such preparation still needs to be evaluated.

RRM Context

The authors note that luteal progesterone is needed for implantation and pregnancy in most species. Restorative reproductive medicine puts the ovulatory cycle first for this reason. The corpus luteum forms after ovulation and makes the progesterone that this trial supplied as replacement.

Our editorial summary of this paper, not the article's abstract.

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.

Topics

By this author

Related research

Reproductive Endocrinology › Luteal Phase › Corpus Luteum Function · Menstrual Cycle › Cycle Physiology › Luteal Phase · Diagnostics › Endometrial Assessment › Luteal Phase Biopsy
Johnny S. Younis, Yossef Ezra, Yoav Sherman, Alex Simon, Joseph G. Schenker, Neri Laufer
J Younis, Y Ezra, Y Sherman, Alexander Simon, Alexandra Simon, A Simon, Joe Schenker, Joey Schenker, J Schenker, N Laufer
PMID 8005273 8005273 DOI 10.1016/s0015-0282(16)56823-x 10.1016/s0015-0282(16)56823-x Younis et al. 1994, Younis 1994

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

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