title: Luteal estradiol pre-treatment coordinates follicular growth during controlled ovarian hyperstimulation with GnRH antagonists.
abstract: BACKGROUND
  The purpose of this study was to investigate whether luteal estradiol (E(2)) administration reduces follicular size discrepancies and enhances ovarian response in recombinant FSH (r-FSH)/GnRH antagonist protocols.
  
  
  METHODS
  We studied prospectively 90 IVF-embryo transfer (ET) candidates who were randomly pre-treated with 17beta-E(2) (4 mg/day) from day 20 until next cycle day 2 (E(2) group, n = 47) or served as controls (control group, n = 43). On day 3, all women started r-FSH treatment. A single 3 mg dose of GnRH antagonist was administered eventually according to follicular maturation. Outcome measures were magnitude of size discrepancy of growing follicles on day 8 of r-FSH treatment and number of follicles >or=16 mm in diameter on the day of HCG.
  
  
  RESULTS
  On day 8, follicles were smaller (9.9 +/- 2.5 versus 10.9 +/- 3.4 mm, P < 0.001) and their size discrepancies attenuated (P < 0.001) in the E(2) group compared with the control group. This was associated with more >or=16 mm follicles, mature oocytes and embryos in the E(2) group.
  
  
  CONCLUSIONS
  Luteal E(2) administration reduces the pace of growth, improves size homogeneity of antral follicles on day 8 of r-FSH treatment and increases the number of follicles reaching maturation at once. Coordination of follicular development optimizes ovarian response to r-FSH/GnRH antagonist protocols and may constitute an attractive approach to improving their outcome.
authors.affiliation: Department of Obstetrics and Gynecology, Clamart, France. renato.fanchin@abc.ap-hop-paris.fr
authors.forename: Renato
authors.initials: R
authors.lastname: Fanchin
authors.forename: Laurent
authors.initials: L
authors.lastname: Salomon
authors.forename: Altina
authors.initials: A
authors.lastname: Castelo-Branco
authors.forename: François
authors.initials: F
authors.lastname: Olivennes
authors.forename: Nelly
authors.initials: N
authors.lastname: Frydman
authors.forename: René
authors.initials: R
authors.lastname: Frydman
mesh_terms: D000328:Adult; D004624:Embryo Transfer; D004958:Estradiol / Q000008:administration & dosage* / Q000097:blood; D005260:Female; D005307:Fertilization in Vitro; D005640:Follicle Stimulating Hormone / Q000008:administration & dosage; D007987:Gonadotropin-Releasing Hormone / Q000037:antagonists & inhibitors*; D006801:Humans; D008183:Luteal Phase; D006080:Ovarian Follicle / Q000033:anatomy & histology / Q000187:drug effects / Q000254:growth & development*; D010062:Ovulation Induction; D011247:Pregnancy; D011374:Progesterone / Q000097:blood; D011446:Prospective Studies; D011994:Recombinant Proteins; D020554:Sperm Injections, Intracytoplasmic
chemical_list: D011994:Recombinant Proteins; D007987:Gonadotropin-Releasing Hormone; D011374:Progesterone; D004958:Estradiol; D005640:Follicle Stimulating Hormone