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This version published online on July 25, 2006
Journal of Clinical Endocrinology & Metabolism , doi:10.1210/jc.2006-0520
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Submitted on March 7, 2006
Accepted on July 10, 2006

Effect of luteal phase support on endometrial L-selectin ligand expression following recombinant follicle stimulating hormone and ganirelix acetate for in vitro fertilization

Nikos F. Vlahos, Christopher W. Lipari, Brandon Bankowski, Tsung-Hsuan Lai, Jeremy A. King, Ie-Ming Shih, Konstantine Fragakis, and Yulian Zhao*

Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Gyn/Ob, Cathay General Hospital, Taipei, Taiwan; Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD; 2nd Department of Obstetrics and Gynecology, University of Athens School of Medicine, Athens Greece; Bloomberg School of Public Health, Baltimore MD

* To whom correspondence should be addressed. E-mail: yzhao1{at}jhmi.edu.

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

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

Patients and Design: Seventeen oocyte donors who underwent ovarian stimulation with a recFSH/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 17{beta}-estradiol. All donors had endometrial biopsies on the day of retrieval, and then 3, 5 and 10 days after retrieval. In addition they had serum E2 and P4 measurements on days 3, 5, and 10.

Main outcome measures: Endometrial L-selectin ligand expression was detected by immunohistochemical staining in the luminal and glandular epithelium. An HSCORE was used for the quantification of the immunostaining. Sex steroid levels were measured during the luteal phase.

Results: By day 10 post 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 17{beta}-estradiol seem to increase endometrial L-selectin ligand expression in the luminal endothelium.
Key words: Luteal phase • endometrium • l-selectin • GnRH antagonists • IVF






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