Vaginal administration of oral micronized estradiol results in successful twin pregnancy in a functionally agonadal woman.
METHODS
A 31-year-old nulligravid woman seeking fertility treatment with in vitro fertilization and intracytoplasmic sperm injection failed to achieve pregnancy. Supernumerary embryos were cryopreserved for future use. In preparation for the transfer of the frozen embryos, the patient was prescribed hormones, which included pituitary down-regulation with leuprolide acetate, followed by oral micronized estradiol (E2) and vaginal progesterone (P4) suppositories. At the time of embryo transfer (ET) it was noted that the patient had misunderstood her instructions and was administering both her estrogen and progesterone vaginally. Ultrasound examination revealed a well-developed endometrium adequate for ET so the procedure was performed, and at that point she was instructed to use E2 orally as originally prescribed. Two weeks later, her beta-hCG was elevated, and subsequent ultrasound examinations revealed a twin gestation. The pregnancy progressed normally.


CONCLUSIONS
This patient's hormones were adequately replaced despite vaginal placement of oral medication. Although not commonly prescribed, oral E2 tablets may be administered vaginally in functionally agonadal women preparing for ET, and may serve as an alternative route for women who experience difficulties with oral formulations.
Chu
Micheline C
MC
Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, College of Physicians and Surgeons, Columbia University, 622 West 168th Street, PH 16-29, New York, NY 10032, USA. mvs9@columbia.edu
Sauer
Mark V
MV
D000282:Administration, Intravaginal; D000284:Administration, Oral; D000328:Adult; D004624:Embryo Transfer; D004958:Estradiol / Q000008:administration & dosage*; D005260:Female; D005307:Fertilization in Vitro; D042341:Gonadal Hormones / Q000008:administration & dosage*; D006801:Humans; D007247:Infertility, Female / Q000209:etiology / Q000628:therapy*; D008508:Medication Errors; D011247:Pregnancy; D011272:Pregnancy, Multiple; D016649:Primary Ovarian Insufficiency / Q000150:complications / Q000188:drug therapy*; D014427:Twins
D042341:Gonadal Hormones; D004958:Estradiol