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LPD and ProgesteroneFrom: George M. Grunert (grunert@ICSI.Net)Sat Aug 31 10:26:20 1996
>Date: Fri, 30 Aug 1996 01:10:31 -0700 >From: John Hellriegel <jhellrie@ubmedd.buffalo.edu> >To: ob-gyn-l@listserv.bcm.tmc.edu >Subject: LPD and Progesterone >Message-ID: <3226A1F7.30B2@ubmedd.buffalo.edu> LPD is a recognized cause for recurrent pregnancy loss, even if a bit over diagnosed and over treated. The first line of treatment in a patient with LPD (2 consecutive out-of-phase late luteal endometrial biopsies) who has low serum progesterone levels at the time of biopsy is with progesterone. Response should be documented by demonstration of elevation of the serum progesterone level as well as correction of the LPD on biopsy. In patients with LPD and a normal progesterone, or in whom the LPD does not correct with normalization of the progesterone level, correction can sometimes be successful by inducing progesterone receptors using clomiphene or gonadotropins. The FDA warning is for progestins of all classes, mostly 19-nor-testosterone derivatives. At an FDA hearing in 1988, evidence was presented and accepted that progesterone itself was not implicated in VACTERL defects or in masculinization of a female fetus. Because progesterone is a non-patented, naturally occurring hormone, compounded locally by pharmacists, the warning was left in place for progestins as a class of drugs marketed by pharmaceutical companies. It has also remained for non-testosterone derivatives, despite evidence presented to the contrary. As an in-vivo experiment, almost all IVF and cryopreserved embryo transfer pregnancies are supported by either progesterone or hCG to induce supraphysiologic progesterone levels. All large, collaborative studies have found no increased incidence of any class of birth defects. I feel the use of progesterone is justified, if it's indication is documented, and the response to therapy is documented. If the indication is not documented, you're on thin ice if anything goes wrong. Mac
-- George M. Grunert, M.D. Director ART Program, Woman's Hospital of Texas 7550 Fannin Houston, TX 77054 713-512-7851 fax 713-512-7853 grunert@icsi.net
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