Effects of pretreatment with estrogens on ovarian stimulation with gonadotropins in women with premature ovarian failure: a randomized, placebo-controlled trial.
OBJECTIVE
To evaluate the hypothesis that pretreatment with estrogens in women affected by premature ovarian failure (POF) may improve the results of ovarian stimulation.


METHODS
Double-blind, randomized, placebo-controlled study.


METHODS
Outpatient department in an academic research environment.


METHODS
Fifty women with POF seeking pregnancy.


METHODS
Before starting ovarian stimulation, group 1 received 0.05 mg ethinyl-E(2) (EE) three times a day for 2 weeks, while group 2 received placebo. Ovarian stimulation was carried out with recombinant FSH (r-betaFSH), 200 IU/day/SC. Both EE and placebo were administered during ovarian stimulation. Human chorionic gonadotropin (10,000 IU/IM) was added when the follicle exceeded a mean diameter of 18 mm.


METHODS
Rate of ovulation in women with POF.


RESULTS
Levels of FSH before stimulation were significantly lower in group 1 than in group 2. The rate of ovulation in group 1 (8/25; 32%) was significantly higher than in group 2 (0/25; 0%). Notably, induction of ovulation was successful only in patients whose FSH levels after EE treatment were < or =15 mIU/mL.


CONCLUSIONS
Our data suggest that pretreatment with EE improves the success of rate of ovulation induction with exogenous gonadotropins in patients with POF. A threshold of FSH < or =15 mIU/mL should be achieved before starting ovarian stimulation.
Tartagni
Massimo
M
Clinica Ostetrica e Ginecologica III, Dipartimento di Farmacologia e Fisiologia Umana, Policlinico di Bari, Università di Bari, Bari, Italy. m.tartagni@gynecology3.uniba.it <m.tartagni@gynecology3.uniba.it>
Cicinelli
Ettore
E
De Pergola
Giovanni
G
De Salvia
Maria Antonietta
MA
Lavopa
Cristina
C
Loverro
Giuseppe
G
D000328:Adult; D006063:Chorionic Gonadotropin / Q000494:pharmacology; D004311:Double-Blind Method; D004958:Estradiol / Q000097:blood; D004997:Ethinyl Estradiol / Q000494:pharmacology*; D005260:Female; D005640:Follicle Stimulating Hormone / Q000097:blood / Q000494:pharmacology*; D006801:Humans; D010053:Ovary / Q000187:drug effects*; D010062:Ovulation Induction; D011247:Pregnancy; D018873:Pregnancy Rate; D016649:Primary Ovarian Insufficiency / Q000188:drug therapy* / Q000503:physiopathology
D006063:Chorionic Gonadotropin; D004997:Ethinyl Estradiol; D004958:Estradiol; D005640:Follicle Stimulating Hormone