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Molecular Diagnosis of Endometrial Receptivity
Published in Carlos Simón, Carmen Rubio, Handbook of Genetic Diagnostic Technologies in Reproductive Medicine, 2022
Maria Ruiz-Alonso, Diana Valbuena, Carlos Simón
Sampling during an HRT cycle is preferred due to its simplicity and consistency. The classic protocol for endometrial preparation begins with the confirmation of ovarian quiescence by ultrasound. Then, estrogen is administered, beginning on the first or second day of menstruation. In Europe, popular preparations include estradiol valerate at a dose of 6 mg/day or estradiol hemihydrate patches delivering 150 μg/48 hours, while in the USA oral estrace at 200 mg/8 hours is favored. Between days 7 and 10 of HRT priming, when endogenous P is < 1 ng/mL and ultrasound assessment reveals a trilaminar endometrium > 6 mm, exogenous P administration is initiated. Vaginal micronized progesterone (or similar) at a dose of 400 mg/12h or 50 mg intramuscular progesterone daily is typically used in Europe or the USA, respectively. The day on which progesterone treatment begins is referred to as P+0, and the biopsy must be taken on day P+5, approximately 120 +/– 3 hours after the first P treatment (Figure 19.2).
New delivery systems for hormone replacement therapy
Published in Barry G. Wren, Progress in the Management of the Menopause, 2020
It has been suggested that intrauterine delivery of a low dose of progestogen might be an excellent means of protecting the endometrium against the excessive proliferative effects of unopposed estrogen, without causing some of the unwanted side-effects of systemic progestogens. Preliminary experience with a levonorgestrel-releasing intrauterine system (Levonova/Mirena®; Leiras, Finland) appears to confirm this promise. This system was designed as a long-acting contraceptive (5- 7 years), but has also proven to be an effective treatment for menorrhagia. The dosage chosen for these indications was a 20-µg daily release rate, and this results in some absorption with measurable circulating levels of around 500 pmol/1. This is highly effective at protecting the endometrium in HRT users39,40, but it appears probable that equally effective protection can be provided by 10-µg or even 5- µg daily release41. At these dosages when combined with oral estradiol valerate, the system remained highly effective at protecting the endometrium, inducing amenorrhea, relieving postmenopausal symptoms and producing beneficial changes in circulating lipids”. At the 2044 dosage, lipid effects were similar to those seen with oral levonorgestrel and were less beneficial41,42. The 20-µg device is relatively wide for insertion into the postmenopausal uterus, and it is to be hoped that reduction of dosage to 5 µg will allow a more slimline version to be manufactured.
Combined hormonal contraception
Published in John Guillebaud, Contraception Today, 2019
This COC contains estradiol valerate (hydrolyzed in vivo to natural estradiol [E2]) and dienogest [DNG], a moderately anti-androgenic progestogen. A complicated phasic regimen (four phases plus two lactose placebos; see Table 2) was unavoidable, because of using natural estrogen, which is less potent than EE. With it, there is comparable cycle control to COCs using 20 μg EE. Absent withdrawal bleeding occurs in approximately 20% of cycles.
Correlation between different endometrial preparation protocols and pregnancy outcome of frozen embryo transfer in patients with polycystic ovary syndrome: a retrospective study
Published in Gynecological Endocrinology, 2023
Yu Pan, Feng Li, Chun-Xia Yang, Yan Sun, Chen-Wang Zhang, Shen-Min Zhang, Tong-Min Xue
In the HRT group, routine vaginal ultrasonography and basic sex hormone tests were performed on the 2nd to 3rd day of the menstrual cycle. Estradiol valerate tablets (manufacturer: Bayer HealthCare Co., Ltd. Guangzhou Branch, China; NMPA approval number: J20130009; strength: 1 mg) were given orally at 2–3 mg/time, twice daily. The dosage was adjusted according to endometrial thickness, with a maximum dose of 4 mg. When estradiol valerate tablets were orally administered for > 10 days and endometrial thickness was > 7 mm, dydrogesterone tablets (manufacturer: Solvay Pharmaceuticals, Netherlands; approval number: JX20010415; strength: 10 mg) were added (20 mg/time orally, once daily) combined with 8% progesterone vaginal sustained-release gel (manufacturer: Merck Serono Limited; approval number: H20140552; strength: 90 mg) (90 mg vaginally, once daily) for endometrial transformation. Cleavage-stage embryos were transferred 4 days later, and medication for luteal support was continued until 10 weeks after pregnancy and gradually reduced.
“Does serum estrogen level have an impact on outcomes in hormonal replacement frozen-warmed embryo transfer cycles?”
Published in Gynecological Endocrinology, 2021
Sita Garimella, Sandeep Karunakaran, Durga Rao Gedela
Patients were called on D1 of menses and a baseline E2 and P4 and a scan was done . FET cycle was started only if E2 < 50 pg/mL and P4 < 1 ng/mL and on scan the endometrium was thin and there was no cyst or a dominant follicle. Oral estradiol valerate tablets were started from the next day with a dose of 2 mg TDS (Progynova, Bayer) and a scan was done after 7 days and depending on the ET, dose adjustments were done. We went upto a maximum dose of 18 mg per day. When ET >7 mm and vascularity was grade 3–4, blood E2 and P4 levels were checked. Progesterone supplementation (100 mg in oil intramuscularly once daily) was started the next day only if P4 < 1 ng/mL. Transfer of one or two blastocysts (depending on patients choice) was performed under USG guidance using a soft catheter 6 days after start of progesterone. Serum beta HCG was done 14 days after transfer and estrogen and progesterone supplementation was continued until 10 weeks if beta HCG was positive. Scan was done at 8 week POG in all the positive cases.
Higher estradiol levels are associated with lower neonatal birthweight after fresh and frozen embryo transfers. A cohort study of 3631 singleton IVF pregnancies
Published in Gynecological Endocrinology, 2021
Theoni Tarlatzi, Christos Venetis, Asma Sassi, Fabienne Devreker, Yvon Englert, Anne Delbaere
FET were performed either in natural cycles, hormonal replacement treatment (HRT), or ovulation induction protocols, according to the clinician’s and patient’s preferences. FET for patients with irregular cycles were preferentially performed on HRT. Endometrial preparation in HRT protocols was done with oral-estradiol valerate from the first day of menstruation (usually 3 × 2 mg/day). If endometrial thickness was ≥7 mm, vaginal micronized progesterone (3 × 200 mg/day) was started and the embryo transfer was planned. Estradiol valerate and progesterone administration were continued throughout the end of the first trimester of pregnancy. Estradiol levels were measured and considered for the analysis, on the day that progesterone supplementation was initiated. Patients who had an embryo transfer in the natural cycle or after ovulation induction, received vaginal micronized progesterone (2 × 200 mg/day) during the luteal phase until 8 weeks of amenorrhea. Estradiol, LH, and progesterone serum levels were measured in all patients during the monitoring of the cycle, including on the day of LH surge, which was the one considered for the study. All blood samples were analyzed straight away.