Human Reproduction, Vol. 15, No. 2, 493,
February 2000
© 2000 European Society of Human Reproduction and Embryology
Letters to the Editor |
Luteal support with vaginal or oral micronized progesterone
Hospital de Clinicas de Porto Alegra, Assisted Fertilization, Centre, Rua Ramiro Barcellos, 2350–11 andar sala 1125, Porto Alegre–RGS, CEP 90051–003, Brazil
Dear Sir,
We read with special interest the recent paper (Friedler et al., 1999
) which compared luteal support with vaginal or oral micronized progesterone following intracytoplasmic sperm injection (ICSI) using a down-regulation protocol. We think that this article has a very useful objective in studying one of the most critical aspects of human assisted reproduction, i.e. luteal support. However we have some questions and comments: firstly, the authors did not show any comparison in terms of luteinizing hormone (LH) secretion during the ovarian stimulation, even in the long protocol, and the body mass index was not compared between the groups. In addition, the difference in implantation rate could be affected by a previous hormonal disease, hyperprolactinaemia or hypothyroidism, both of them also associated with luteal insufficiency, not explored by the authors.
The quality of the embryos transferred should be controlled, and the low number of patients studied could be the reason for the non-difference between the groups in ongoing pregnancy rate/embryo transfer and miscarriages, since the differences between the groups, showed in the paper were very large.
It would be better, also, to present the results of oestradiol secretion in tables with the level of significance and the statistics used. We were surprised with the low oestradiol concentration in the group of pregnant women receiving oral progesterone. The authors should discuss these findings further.
We agree with the authors that the vaginal administration could provide a better bioavailability, because of the uterine–vaginal circulation, but this paper has some methodological problems that interfere in the results.
We suggest that a discussion on these subjects would provide better support regarding those important conclusions.
Notes
1 To whom correspondence should be addressed.
References
Friedler, S., Raziel, A., Schachter, M. et al. (1999) Luteal support with micronized progesterone following in-vitro fertilization using a down-regulation protocol with gonadotrophin-releasing hormone agonist: a comparative study between vaginal and oral administration. Hum. Reprod., 14, 1944–1948.
IVF and Infertility Unit, Assaf Harofeh Medical Center, Zerifin 70300, Israel
Dear Sir,
We are grateful for the interest of Dr Cunha-Filho and Dr Passos in our paper. In reply to their questions and concerns, the two treatment groups received similar pituitary down-regulation stimulation protocols, therefore we did not check and compare their luteinizing hormone (LH) concentrations. Suffice to say that no stimulation was started until down-regulation had been established by serum oestradiol concentrations of <30 pg/ml. No difference was noted between their mean body mass index (BMI), although this was not mentioned in our paper. In all patients treated in our in-vitro fertilization (IVF) programme, both hyperprolactinaemia and hypothyroidism were ruled out or treated as a routine procedure, before entering any treatment cycle. Therefore, the two groups were quite similar and comparable.
Concerning serum oestradiol concentrations, although presentable in a table, we preferred to illustrate our results in a graphic way, in a line graph. We feel that this form of presentation is not only as legitimate as a table but sometimes even more interesting to the reader's eye. The mean values, for each day, represented in the graph were compared between the groups, using Student's t-test and the differences were not statistically significant. As already mentioned in the paper, the decline in oestradiol concentrations from day of human chorionic gonadotrophin (HCG) administration to day 11 has been reported previously. Although lower concentrations of oestradiol were noted in the group treated orally, this difference had no significance statistically, meaning that they could be explained only by chance, and developing a theory concerning this phenomenon would be premature. In both groups once implantation has occurred, the oestradiol concentrations were raised, probably due to the rescue effect of HCG present in the circulation, on the corpus luteum.
We are content that the results of our paper are well taken by our colleagues and are quite confident that our methodology was quite satisfactory to support them.
Notes
1 To whom correspondence should be addressed.
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