Effects of pretreatment with estrogens on ovarian stimulation with gonadotropins in women with premature ovarian failure: a randomized, placebo-controlled trial

ObjectiveTo evaluate the hypothesis that pretreatment with estrogens in women affected by premature ovarian failure (POF) may improve the results of ovarian stimulation.DesignDouble-blind, randomized, placebo-controlled study.SettingOutpatient department in an academic research environment.Patient(s)Fifty women with POF seeking pregnancy.Intervention(s)Before starting ovarian stimulation, group 1 received 0.05 mg ethinyl-E2 (EE) three times a day for 2 weeks, while group 2 received placebo. Ovarian stimulation was carried out with recombinant FSH (r-βFSH), 200 IU/day/SC. Both EE and placebo were administered during ovarian stimulation. Human chorionic gonadotropin (10,000 IU/IM) was added when the follicle exceeded a mean diameter of 18 mm.Main Outcome MeasureRate of ovulation in women with POF.Result(s)Levels of FSH before stimulation were significantly lower in group 1 than in group 2. The rate of ovulation in group 1 (8/25; 32%) was significantly higher than in group 2 (0/25; 0%). Notably, induction of ovulation was successful only in patients whose FSH levels after EE treatment were ≤15 mIU/mL.Conclusion(s)Our data suggest that pretreatment with EE improves the success of rate of ovulation induction with exogenous gonadotropins in patients with POF. A threshold of FSH ≤15 mIU/mL should be achieved before starting ovarian stimulation.