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Is there evidence for preferential delivery of ovarian estradiol to the endometrium?
D E Tourgeman1, R Boostanfar, L Chang
1Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, University of Southern California Keck School of Medicine, Los Angeles, California 90033, USA.
Objective:
To determine the direction of delivery of E(2) in the female pelvis by assessing the ratio of endometrial to serum E(2) in women whose ovaries were stimulated to produce E(2) with women who received exogenous E(2).
Design:
Prospective comparative study.
Setting:
University-based ART program.
Patient(S):
Oocyte donors and recipients of donor oocytes.
Intervention(S):
Micronized E(2) administered by the oral or vaginal route and oocyte donation.
Main Outcome Measure(S):
Serum and endometrial levels of E(2).
Result(S):
Serum E(2) levels were significantly higher in women who underwent controlled ovarian hyperstimulation (COH) and women receiving exogenous E(2) by the vaginal route than in those who received oral E(2). Levels of E(2) in endometrial tissue were similar in women who underwent COH and those receiving oral E(2). Endometrial E(2) levels in women who underwent vaginal administration were significantly higher than those in the oral E(2) or COH groups. The ratio of endometrial to serum E(2) was highest in women who underwent vaginal E(2) and lowest in those undergoing COH.
Conclusion(S):
Vaginal administration of micronized E(2) results in preferential absorption of E(2) into the endometrium, consistent with a "uterine first pass" effect. Since endogenous E(2) produced the smallest ratio of E(2) between the endometrium and serum, E(2) produced by the ovaries is not preferentially delivered to the uterus.
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