Endometrial Preparation

In vitro fertilization (IVF), which was originally designed to treat infertility resulting from tubal factors, has made female gamete donation possible. Having mastered the techniques for oocyte collection and extra corporal fertilization, it remained to establish how to induce endometrial receptivity using exogenous hormones. Not having a better model to follow than the menstrual cycle, early investigators aimed at modulating hormone treatments to duplicate the physiological profiles of plasma E2 and progesterone levels.1,2 Initial reports of pregnancies achieved by oocyte donation in agonadal women have been rapidly followed by both small and large series claiming successes that far eclipse standards for other infertility treatments. 2–6 Interestingly, these results often exceed those obtained in “ regular” IVF patients, even when oocytes were equally distributed between donors and recipients.7 The latter observation was used to argue in support of the hypothesis that improved pregnancy rates in recipients of donated eggs result from enhanced endometrial receptivity since pharmacologically high levels of hormones induced by fertility drugs are avoided,6,7 a view recently challenged by others, however.8 Beyond the controversy of possible detrimental effects of high estrogen levels it now has been clearly established that hormone replacement schemes developed for egg donation succeed in achieving optimal endometrial receptivity, a phenomenon not affected by the recipient’s age.9 The great predictability with which hormone replacement cycles induce endometrial receptivity in recipients has led to extended clinical use in two distinct areas: (1) as a model to study hormonal effects pertinent to the control of receptivity10–13 and (2) as a surrogate for the menstrual cycle to optimally time transfers of cryopreserved14 or donated embryos15 in women whose ovaries remain active. Various efforts in the field have demonstrated flexibility in doses, treatment duration,10,13,16 routes of administration17–19 and various simplification options. It also unveiled some unexpected findings with general implications for gynecology such as the privileged transport to the uterus of vaginally administered substances like progesterone,20–22 a phenomenon now referred to as the uterine “ first pass” effect.21–22 Preview Unable to display preview. Download preview PDF. Similar content being viewed by others

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Editor information Editors and Affiliations Rights and permissions Copyright information © 1998 Springer Science+Business Media New York About this chapter Cite this chapter de Ziegler, D., Bulletti, C., de Moustier, B. (1998). Endometrial Preparation. In: Sauer, M.V. (eds) Principles of Oocyte and Embryo Donation. Springer, New York, NY. https://doi.org/10.1007/978-1-4612-1640-7_6 Download citation DOI: https://doi.org/10.1007/978-1-4612-1640-7_6 Publisher Name: Springer, New York, NY Print ISBN: 978-1-4612-7226-7 Online ISBN: 978-1-4612-1640-7 eBook Packages: Springer Book Archive

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