陰道黃體素比口服黃體素更有效改善子宮內膜環境

病理切片顯示，陰道投藥黃體素比口服黃體素更有效改善子宮內膜環境

http://humrep.oxfordjournals.org/content/22/5/1260.full

Effect of oral administration of dydrogestrone versus vaginal administration of natural micronized progesterone on the secretory transformation of endometrium and luteal endocrine profile in patients with premature ovarian failure: a proof of concept

1. H.M. Fatemi1,3, 
2. C. Bourgain2, 
3. P. Donoso1, 
4. C. Blockeel1,
5. E.G. Papanikolaou1, 
6. B. Popovic-Todorovic1 and 
7. P. Devroey1

+Author Affiliations

1. ¹Centre for Reproductive Medicine
2. ²Department of Pathology, Dutch-Speaking Free University Brussels, Laarbeeklaan, Brussels, Belgium

1. 3To whom correspondence should be addressed at: V.U.B/C.R.G., Laarbeeklaan 101, 1090 Brussels, Belgium. Tel:             +32 2 4776699 begin_of_the_skype_highlighting            +32 2 4776699      end_of_the_skype_highlighting      ; Fax: +33 2 4776333; E-mail: hmousavi@az.vub.ac.be

• Received August 22, 2006.
• Revision requested October 3, 2006.
• Accepted December 10, 2006.

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Abstract

BACKGROUND We aimed to explore the endometrial histology and endocrine profiles on day 21 of an artificial cycle in patients with premature ovarian failure (POF) treated with oral dydrogesterone (DG) or vaginal micronized progesterone.

METHODS The study was designed as a prospective pilot study at an academic reproductive medicine unit. Six POF patients were included in the study. After estrogen endometrial priming, patients were randomized to receive DG or progesterone in two subsequent cycles. The main outcome measure was the endometrial histology and the endocrine profiles on day 21 of the cycle.

RESULTS Development of endometrial glands corresponded to an early secretory phase in five out of six cases supplemented with DG (out-phase). In contrast, five out of six cases treated with micronized progesterone showed an endometrium corresponding to a mid-luteal phase (in-phase) (P = 0.021 versus DG). There was a significant difference in the mean progesterone value [8.6 versus 0.3 µg l⁻¹ (P = 0.013)], the mean LH value [12.9 versus 22.5 IU l⁻¹ (P = 0.049)] and the mean FSH value [13.0 versus 23.9 IU l⁻¹ (P = 0.047)] between the progesterone and DG group, respectively, on day 21 of the cycle.

CONCLUSIONS After estrogen endometrial priming in POF patients, exogenous vaginal micronized progesterone is more effective than oral DG in creating an ‘in-phase’ secretory endometrium and induces significantly higher progesterone and lower LH and FSH serum concentrations on day 21 of the cycle.