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Comparison of transdermal versus oral estradiol on endometrial receptivity
J S Krasnow1, B A Lessey, G Naus
1Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, Pennsylvania 15213, USA.
Objective:
To compare the effects of oral micronized E2 with transdermal E2 on endometrial receptivity in women undergoing oocyte donation.
Design:
Prospective, randomized, crossover trial. Serum E2 and P concentrations were measured on cycle days 14 and 22 (luteal day +8). Endometrial biopsies were obtained on day 22 and read in a blinded fashion for histology and beta-3-integrin expression.
Setting:
University-based donor oocyte program.
Patients:
Twenty-seven patients presenting for donor oocytes.
Main Outcome Measures:
Endometrial histology and beta-3-integrin expression.
Results:
The endometrial glandular histology in women given oral micronized E2 was delayed by a mean of 1.6 days in comparison to that of women given transdermal E2. Seventy percent of women given oral E2 displayed a lag > or = 4 days whereas 29.6% given transdermal E2 displayed a similar lag. Serum E2 levels were 1,194 +/- 108.8 pg/mL (mean +/- SEM; conversion factor to SI unit, 3.671) in women on oral micronized E2 and 117.4 +/- 14.0 pg/mL in those on transdermal E2.
Conclusion:
The supraphysiologic serum E2 levels associated with oral micronized E2 may have a deleterious impact on endometrial receptivity. The development of more physiologic hormone replacement protocols may enhance endometrial receptivity and lead to improved clinical pregnancy rates.