Estradiol valerate

Abstract

Endometrial collection: case report A 36-year-old woman developed endometrial collection during treatment with estradiol valerate as hormone replacement therapy (HRT). The woman diagnosed with Mosaic Turner’s syndrome presented for oocyte donation program (ODP). She got her periods only after taking a course of unspecified combined oral contraceptives. Her medical history included diabetes and she was on metformin and insulin therapy. She was given 4 cycles of sequential regimen estradiol valerate [estrogen] 10–12mg daily and progesterone to improve the vascularity before ODP. She was initiated on HRT, that was, estradiol valerate 8mg for the trial cycle, but she developed an endometrial collection along with hypoechoic fluid collection with maximum anteroposterior diameter of about 6mm. Progesterone was stopped. Meanwhile, the oocytes were fertilised with husband’s sperm and were frozen at eight cell stage by vitrification, to be transferred after the resolution of the endometrial collection. However, she developed endometrial collection after each cycle of estradiol valerate. Therefore, the woman’s estradiol valerate cycles were cancelled. Her histopathology report revealed oedematous stroma with scanty endometrium. Thus, she was empirically treated with doxycyline and clindamycin for 14 days. She was again started on estradiol valerate twice, but she again developed an echogenic endometrial collection. Therefore, cervical dilatation and suctioning of the endometrial cavity were done under ultrasound guidance. It drained only scanty old blood clots and the endometrial collection persisted on continuing estradiol valerate. Therefore, later she was treated with low dose transdermal estradiol. She did not develop an endometrial collection this time, but the growth of the endometrium was slow. She was given granulocyte-colony stimulating factors for improving endometrial thickness while continuing estrogen. After 28 days of transdermal estrogen, she developed an endometrium of 5.7mm with zone three vascularity according to Applebaum scoring. Since it was the best endometrium thickness, a decision for embryo transfer was made. She was initiated on vaginal micronised progesterone 300mg thrice daily for 5 days. Two embryos at eight cell stage (grade 1) were thawed with Kitazatos thawing medium, and assisted laser hatching was done by diode laser in the compaction stage and transferred on the fifth day of progesterone. She conceived after embryo transfer. Treatment with metformin and insulin was continued during her pregnancy [pregnancy outcome not stated].