ulipristal acetate on progesterone levels and glycodelin-a endometrial pattern

Conditions: Infertility

Summary: controlled ovarian stimulation (cos) for fiv increases progesterone (p) and estradiol (e2) serum levels in supraphysiologic concentrations at the end of follicular phase. elevated serum p levels leads to an accelerated endometrial maturation which interferes with the dialogue between embryo and endometrium. it has been reported that serum progesterone levels ≥ 1.5 ng/ml on the last day of cos are related to a significant decrease in the ongoing pregnancy rate following ivf cycles. also, it has been reported a significant alteration in the endometrial gene expression profile related to p elevated levels. glycodelin-a is an immunomodulatory glycoprotein synthesized by luteal-phase endometrial epithelium and its expression seems to be related to the action of p. because glycodelin-a has immunosuppressive activity, it may facilitate the process of implantation and the maintenance of pregnancy. it is already know that ulipristal acetate (upa) decrease serum p levels. the hypothesis of this study is that upa is been able to modify p serum levels and glycodelin-a endometrial expression pattern on fsh/gnrh antagonist cycles for fiv.

controlled ovarian stimulation (cos) for fiv increases progesterone (p) and estradiol (e2) serum levels in supraphysiologic concentrations at the end of follicular phase. elevated serum p levels leads to an accelerated endometrial maturation which interferes with the dialogue between embryo and endometrium. it has been reported that serum progesterone levels ≥ 1.5 ng/ml on the last day of cos are related to a significant decrease in the ongoing pregnancy rate following ivf cycles. also, it has been reported a significant alteration in the endometrial gene expression profile related to p elevated levels. glycodelin-a is an immunomodulatory glycoprotein synthesized by luteal-phase endometrial epithelium and its expression seems to be related to the action of p. because glycodelin-a has immunosuppressive activity, it may facilitate the process of implantation and the maintenance of pregnancy. objective: to evaluate the endometrial effect of progesterone through glycodelin-a expression pattern on women exposed or not to ulipristal acetate in gnrh antagonist cycles using two different doses of fsh for ovarian controlled stimulation. methods: prospective controlled randomized study. it will be enrolling 16 oocytes donors from oocyte donation program of proar (a reproductive center of rosario, argentina). on day 3 of menstrual cycle fsh serum levels and antral follicular count (afc) will be measure. if those results fulfill with inclusions criteria, patients will be randomize for fsh 225ui or 300ui gnrh-antagonist/ urinary fsh protocol. p serum levels will be measure every 48 hours since at least 1 follicle ≥14 mm will be achieve until at least 1 follicle reach 19mm of diameter. the next day of hcg administration a new p circulating will be measure and then the patient will be randomize trough opaque envelopes for receive 30mg of ulipristal acetate or placebo. an endometrial biopsy with cornier´s pipelle will be performing 3 and 5 days after hcg injection (hcg+3 and hcg+5 days) to evaluate endometrial dating and glycodelin-a expression pattern. statistical analysis: nominal variables will be analyzing using t-student test and the effect of ulipristal with anova.

Eligibility criteria:
inclusion criteria: * age \<35 years old * fsh on day 3: \<12 ui/ml * antral follicular count ≥ 6 on day 3 of the cycle * bmi: \<30 kg/m2 exclusion criteria: * hypothyroidism * hyperprolactinemia * kidney or liver disease * smoking * alcoholism

Keywords: progesterone glycodelin-a ulipristal acetate