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.
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 microg 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.
Fatemi
H M
HM
Centre for Reproductive Medicine, Dutch-Speaking Free University Brussels, Laarbeeklaan, Burssels, Belgium. hmousavi@az.vub.ac.be
Bourgain
C
C
Donoso
P
P
Blockeel
C
C
Papanikolaou
E G
EG
Popovic-Todorovic
B
B
Devroey
P
P
D000282:Administration, Intravaginal; D000284:Administration, Oral; D000328:Adult; D004394:Dydrogesterone / Q000008:administration & dosage*; D004717:Endometrium / Q000166:cytology* / Q000187:drug effects; D004958:Estradiol / Q000097:blood; D005260:Female; D005640:Follicle Stimulating Hormone / Q000097:blood; D006801:Humans; D008183:Luteal Phase / Q000502:physiology; D007986:Luteinizing Hormone / Q000097:blood; D010865:Pilot Projects; D016649:Primary Ovarian Insufficiency / Q000188:drug therapy*; D011374:Progesterone / Q000008:administration & dosage* / Q000097:blood
D011374:Progesterone; D004958:Estradiol; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone; D004394:Dydrogesterone