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Effect of Luteal-Phase Support on Endometrial L-Selectin Ligand Expression after Recombinant Follicle-Stimulating Hormone and Ganirelix Acetate for in Vitro Fertilization

Departments of Gynecology and Obstetrics (N.F.V., C.W.L., B.B., T.-H.L., J.A.K., Y.Z.) and Pathology (I.-M.S.), Johns Hopkins University School of Medicine, Baltimore, and Bloomberg School of Public Health (K.F.), Baltimore, Maryland 21205; Department of Gynecology/Obstetrics (T.-H.L.), Cathay General Hospital, Taipei 106, Taiwan; Department of Medicine (T.-H.L.), School of Medicine, Fu Jen Catholic University, Taipai, Taiwan, Republic of China 24205; and Second Department of Obstetrics and Gynecology (N.F.V.), University of Athens School of Medicine, 11528 Athens, Greece

Address all correspondence and requests for reprints to: Yulian Zhao Ph.D., 601 North Caroline Street, JHOC 1211, Baltimore, Maryland 21287. E-mail: yzhao1{at}jhmi.edu.

Context: The impact of different types of luteal phase support on endometrial receptivity after ovarian stimulation has not been investigated.

Objective: Our objective was to evaluate the impact of different luteal-phase support protocols on sex steroid levels and on endometrial expression of L-selectin ligand after ovarian hyperstimulation with a GnRH antagonist protocol.

Patients and Design: Seventeen oocyte donors who underwent ovarian stimulation with a recombinant FSH/ganirelix acetate protocol were randomized into three groups: group I had no luteal-phase support; group II had luteal support with micronized progesterone; and group III had luteal support with progesterone plus 17ß-estradiol. All donors had endometrial biopsies on the day of retrieval, and then 3, 5, and 10 d after retrieval. In addition, they had serum estradiol and progesterone measurements on d 3, 5, and 10.

Main Outcome Measures: Endometrial L-selectin ligand expression was detected by immunohistochemical staining in the luminal and glandular epithelium. A histological score was used for the quantification of the immunostaining. Sex steroid levels were measured during the luteal phase.

Results: By d 10 after retrieval, there was a significant decrease in mean progesterone levels in group I compared with the other two groups that may reflect the expected demise of the corpus luteum. There was also a significant increase in the presence of L-selectin ligands in the luminal epithelium in group III.

Conclusions: During controlled ovarian stimulation with a GnRH antagonist protocol, luteal-phase support with micronized progesterone and 17ß-estradiol seem to increase endometrial L-selectin ligand expression in the luminal endothelium.