Artificially Induced Endometrial Cycles and Establishment of Pregnancies in the Absence of Ovaries

Abstract

In eight women with ovarian failure, we induced histologically normal endometrial function during a preparatory cycle consisting of sequential administration of estrogen and progesterone. During a subsequent cycle, endometrial stimulation was synchronized with surrogate-embryo transfer performed on days 16 to 21. Among the eight women, two pregnancies were established by embryo transfer on days 18 and 19. In both women, ovarian tissue was absent, and these patients therefore serve as an in vivo model for the isolated effects of estrogen and progesterone on implantation and maintenance of pregnancy. Treatment with exogenous estrogen was mandatory up to the 11th week of gestation, and treatment with progesterone until the 18th to 22nd weeks. We conclude that it is biologically feasible to simulate the essential hormonal and endometrial milieu of a fertile menstrual cycle and early gestation solely by the administration of estrogen and progesterone. Days 18 to 19 of the cycle are recommended for successful embryo implantation with this treatment program.

A shared egg donor program: which is the minimum number of oocytes to be allocated?

“…In the early eighties the first experiences with oocyte donation took place in women without ovaries or ovarian function [1][2][3]. Initially, egg donation was used to treat young women with premature ovarian failure or with surgically inaccessible ovaries.…”

Hormonal regulation and localization of estrogen, progestin and androgen receptors in the endometrium of nonhuman primates: effects of progesterone receptor antagonists

“…Progesterone is an essential reproductive hormone that acts on the estrogen primed endometrium to induce conditions favorable for embryo implantation (Navot et al, 1986;Ghosh and Sengupta, 1989), and the maintenance of pregnancy (Hodgen and Tullner, 1975). The genomic effects of P are mediated in target cells through interactions with specific intracellular progesterone receptors (PR).…”

Subcutaneous estradiol pellets for endometrial preparation in donor oocyte recipients with a poor endometrial response

“…Oral estradiol valerate (t 1), oral estradiol with estriol at a 2:1 ratio (12), oral micronized estradiol (3), transdermal estradiol patches (6), estradiol in a silastic vaginal ring (3), micronized estradiol vaginal tablets (13), and intramuscularly (im) injectable estradioI valerate (14) have all been used with varying degrees of success. Each one of these methods requires repeated, frequent administrations, and all have individually variable absorption rates and variable bioavailability and give variable serum estrogen levels.…”