Effect of mifepristone on folliculogenesis in women treated with recombinant FSH

Messinis, Ioannis E.; Krishnan, Monica; Kazem, Rahnuma; Khadilkar, Suvarna; Templeton, Allan

doi:10.1046/j.1365-2265.1997.1290951.x

Cited by 16 publications

(5 citation statements)

References 21 publications

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“…An endogenous LH surge was noted in 6/9 patients in the first cycle, but none in the second. The major drawback was mifepristone’s adverse effect on folliculogenesis and decreased estradiol and progesterone levels in the luteal phase [28]. A more recent pilot study of 15 healthy oocyte donors undergoing ovarian stimulation for IVF investigated the effectiveness of daily mifepristone in comparison to GnRH agonist to prevent premature LH surge.…”

Section: Discussionmentioning

confidence: 99%

Nimodipine, a calcium channel blocker, delays the spontaneous LH surge in women with regular menstrual cycles: a prospective pilot study

Nayot

Klachook

Casper

2013

Reprod Biol Endocrinol

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BackgroundCurrently GnRH analogue injections are used to prevent premature LH surges in women undergoing assisted reproductive technology. This was a pilot study to determine the safety and effectiveness of nimodipine, an oral calcium channel blocker, to delay the mid-cycle spontaneous LH surge in women with regular menstrual cycles.MethodsEight women with regular menstrual cycles self-monitored three consecutive cycles for the day of an LH surge by daily urine assay. The first and third cycles were observatory. In the second cycle, subjects took nimodipine 60 mg by mouth three times daily for four days, starting two days prior to the expected LH surge day based on cycle one.ResultsThe LH surge day in cycle 2 (nimodipine) was significantly delayed in comparison to both observatory cycle 1 (15.5+/−3.4 vs 14.0+/−2.8 days; p = 0.033) and cycle 3 (15.1+/−3.5 vs 13.1+/−2.4 days; p = 0.044). There was no difference in the LH surge day between the two observatory cycles (13.4+/−2.4 vs 13.1+/−2.4 days; p = 0.457). Three patients experienced a mild headache.ConclusionsThere was a statistically significant delay in the spontaneous LH surge day in the treatment cycle in comparison to both observatory cycles. Nimopidine should be further investigated as an oral alternative to delay a spontaneous LH surge.

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Section: Discussionmentioning

confidence: 99%

Nimodipine, a calcium channel blocker, delays the spontaneous LH surge in women with regular menstrual cycles: a prospective pilot study

Nayot

Klachook

Casper

2013

Reprod Biol Endocrinol

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“…However, in case the delay is followed by ovulation, it does not affect implantation (Ghosh et al, 1997). Although it is generally assumed that the principle mode of action is established through inhibition of E 2 feedback, inhibitory effects at the hypothalamus (Heikinheimo et al, 1995(Heikinheimo et al, , 1996Kazem et al, 1996), the pituitary (Van Uem et al, 1989;Wolf et al, 1989;Sanchez-Criado et al, 1999) or a direct effect at the ovary (Dimattina et al, 1986;Messinis et al, 1997) have also been suggested.…”

Section: Anti-progestinsmentioning

confidence: 99%

Residual ovarian activity during oral steroid contraception

Heusden¹

2002

Human Reproduction Update

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Steroid drugs with contraceptive properties have been available in the clinical setting for over four decades and are still subject to improvement. Estrogens, progestins and anti-progestins have been used alone or in various combinations, regimens and routes of administration to favour the balance between efficacy and undesirable effects. One of the most important changes in this respect is the gradual lowering of steroid dosage in commercially available contraceptives. Current steroid contraceptive pills still achieve the goal of suppression of pituitary-ovarian activity, but the margins for error are minimal. In this review the available data on modes of action and the effects on suppressing pituitary-ovarian activity by different forms of oral contraception are reassessed. Although pregnancy rates provide a crude measure of contraceptive efficacy, no benchmark for pituitary-ovarian inhibition is available to test the suppressive potential of contraceptive drugs. Consequently, many studies provide incomplete and/or incomparable results. For the further study of those forms of steroid contraception that rely predominantly on suppression of ovarian activity, prevention of dominant follicles selection should be the objective.

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“…These results suggest that mifepristone arrests follicular development at a stage beyond the recruitment‐selection point by delaying the growth of the dominant follicle. This is probably achieved through an effect of mifepristone on the ovary where it reduces the sensitivity of the selected follicle to FSH 15 …”

Section: Effect On the Ovarymentioning

confidence: 99%

“…This is probably achieved through an effect of mifepristone on the ovary where it reduces the sensitivity of the selected follicle to FSH. 15 In an experiment in monkeys to test the hypothesis that inhibition of preovulatory phase progesterone action can inhibit or delay ovulation, observations have suggested that administration of mifepristone in the follicular phase can inhibit or disrupt follicular maturation. 16 The effect of mifepristone 0.1 mg or 0.5 mg daily was studied in 10 women for three menstrual cycles.…”

Section: Drug Focusmentioning

confidence: 99%

The Potential of Mifepristone (Ru486) as a Female Contraceptive Drug

Sarkar

2002

Int J Clinical Practice

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SUMMARYThis article reviews the development of mifepristone (RU486) as a female contraceptive drug. Mifepristone is an orally active compound with nearly 40% bioavailability after first pass effect. The steady plasma level of mifepristone ranges from 65 nmol/l with 1 mg/day to 1 μmol/l with 10 mg/day and reaches 2.5 μmol/l, 4.5 μmol/l and 5.4 μmol/l with mifepristone 50 mg, 100 mg and 200 mg daily, respectively, over the treatment period. Inhibition of ovulation may be achieved at serum mifepristone concentration of 232.7 nmol/l. Mifepristone appears to antagonise progesterone at the pituitary level to suppress gonadotropin and steroid hormone secretion rather than to act primarily on the hypothalamus to delay or inhibit ovulation. In fact, the endometrium is most sensitive to mifepristone. Low‐dose mifepristone impairs luteal phase endometrial development and receptivity by altering endometrial parakine, cytokine and enzyme activity. Thus, low‐dose mifepristone can significantly reduce the rate of conception without inhibiting ovulation. However, further research is needed to standardise the dose and dose‐schedule to achieve the desired efficacy of low‐dose mifepristone for routine clinical use with minimal or no side‐effects.

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Effect of mifepristone on folliculogenesis in women treated with recombinant FSH

Cited by 16 publications

References 21 publications

Nimodipine, a calcium channel blocker, delays the spontaneous LH surge in women with regular menstrual cycles: a prospective pilot study

Nimodipine, a calcium channel blocker, delays the spontaneous LH surge in women with regular menstrual cycles: a prospective pilot study

Residual ovarian activity during oral steroid contraception

The Potential of Mifepristone (Ru486) as a Female Contraceptive Drug

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