Severe hypertriglyceridemia and pancreatitis following hormone replacement prior to cryothaw transfer.
OBJECTIVE
A case of acute pancreatitis with severe hypertriglyceridemia occurred following use of intramuscular estradiol valerate during endometrial preparation for cryopreserved embryos.


METHODS
A 30-year-old woman with primary infertility and a past history of well-controlled hypothyroidism, underwent endometrial development with intramuscular estradiol valerate in preparation for the transfer of cryopreservred embryos.


RESULTS
Initial hospitalization, discontinuation of all estrogens, aggressive intravenous fluid hydration, and initiation of low-fat diet with additional gemfibrozil treatment resulted in complete resolution of all symptoms related to the pancreatitis including the hyperlipidemia. A subsequent cryothaw cycle using oral estradiol resulted in a viable pregnancy with only mild increases in the patient's triglyceride and cholesterol levels noted throughout her 38-week gestation.


CONCLUSIONS
Estradiol valerate, a commonly used form of estrogen for endometrial preparation during cryothaw cycles, may cause severe hypertriglyceridemia and acute pancreatitis in certain predisposed individuals. Oral and transdermal estrogens should be the preferred method of endometrial preparation in patients at high risk for lipid metabolism disorders, such as patients with polycystic ovarian syndrome and familial hypertriglyceridemia. These estrogens are more rapidly metabolized and have a shorter half life compared to that of estradiol valerate.
Ruman
Jane
J
Department of Obstetrics and Gynecology, Long Island Jewish Medical Center, New Hyde Park, New York, USA. jruman6129@aol.com
Brenner
Steven
S
Sauer
Mark V
MV
D015925:Cryopreservation; D004624:Embryo Transfer; D004717:Endometrium / Q000187:drug effects / Q000502:physiology; D004958:Estradiol / Q000009:adverse effects* / Q000031:analogs & derivatives* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D015228:Hypertriglyceridemia / Q000139:chemically induced* / Q000188:drug therapy; D007231:Infant, Newborn; D007247:Infertility, Female / Q000628:therapy*; D007273:Injections, Intramuscular; D008297:Male; D010195:Pancreatitis / Q000139:chemically induced* / Q000188:drug therapy; D017584:Reproductive History
D004958:Estradiol