Louise Greenberg

Effects of Postmenopausal Estrogen Replacement on the Concentrations and Metabolism of Plasma Lipoproteins

Abstract Background. Postmenopausal estrogen-replacement therapy may reduce the risk of cardiovascular disease, and this beneficial effect may be mediated in part by favorable changes in plasma lipid levels. However, the effects on plasma lipoprotein levels of postmenopausal estrogens in the low doses currently used have not been precisely quantified, and the mechanism of these effects is unknown. Methods. We conducted two randomized, double-blind crossover studies in healthy postmenopausal women who had normal lipid values at base line. In study 1, 31 women received placebo and conjugated estrogens at two doses (0.625 mg and 1.25 mg per day), each treatment for three months. In study 2, nine women received placebo, oral micronized estradiol (2 mg per day), and transdermal estradiol (0.1 mg twice a week), each treatment for six weeks. The metabolism of very-low-density lipoprotein (VLDL) and low-density lipoprotein (LDL) was measured by endogenously labeling their protein component, apolipoprotein B. Resu...

Crinone vaginal gel is equally effective and better tolerated than intramuscular progesterone for luteal phase support in in vitro fertilization–embryo transfer cycles: a prospective randomized study

OBJECTIVE To compare the efficacy of Crinone vaginal gel and intramuscular progesterone (IMP) for luteal phase support in in vitro fertilization-embryo transfer (IVF-ET) with respect to pregnancy rates and outcomes, and to assess patient satisfaction with both products. DESIGN Prospective randomized trial. SETTING University-affiliated IVF unit. PATIENT(S) Women under age 40 years with day-3 follicle-stimulating hormone levels <15 mIU/mL undergoing their first, second, or third IVF cycles on gonadotropin releasing-hormone (GnRH) down-regulation protocols. INTERVENTION(S) Luteal phase supplementation with either Crinone vaginal gel or IMP; phone survey regarding patient satisfaction with Crinone vaginal gel and IMP. MAIN OUTCOME MEASURE(S) Pregnancy rates, ongoing/delivered, failed pregnancy rates, and product satisfaction scores for patients supplemented with Crinone vaginal gel and with IMP. RESULT(S) Four hundred sixty-eight patients were randomized, and 407 completed the study. The patients were randomized on the day of oocyte retrieval to receive either Crinone vaginal gel or IMP for luteal phase support. Pregnancy, ongoing/delivered, and failed pregnancy rates were similar between the Crinone and IMP treatment arms (OR [95% CI]: 1.2 [0.8, 1.8], 1.1 [0.8, 1.7], 1.0 [0.6, 1.7], respectively). On a scale of 1 to 5, patient satisfaction scores were statistically significantly higher with Crinone vaginal gel than with IMP (4.4 ± 0.9 vs. 2.8 ± 1.2). CONCLUSION(S) Crinone vaginal gel and IMP are equally effective for luteal phase support in IVF, but Crinone is better tolerated by patients.

Patterns of luteal phase bleeding in in vitro fertilization cycles supplemented with Crinone vaginal gel and with intramuscular progesterone—impact of luteal estrogen: prospective, randomized study and post hoc analysis

OBJECTIVE To compare patterns of luteal phase bleeding (LPB) in IVF cycles supplemented with Crinone and with intramuscular progesterone (IMP) and to evaluate the impact of luteal estrogen supplementation on LPB. DESIGN Prospective, randomized trial and post hoc analysis. SETTING University-affiliated IVF unit. PATIENT(S) Women under age 40 with day 3 FSH <15 mIU/mL were randomized to receive either Crinone or IMP for luteal phase support. Luteal estrogen was prescribed according to clinical protocols. Three hundred sixty-five patients were queried about LPB after completion of their IVF cycles. INTERVENTION(S) Luteal phase supplementation with Crinone or IMP and with estrogen. MAIN OUTCOME MEASURE(S) Incidence of LPB in IVF cycles supplemented with Crinone and IMP and impact of luteal estrogen on the occurrence of LPB. RESULT(S) There was no difference in the overall incidence of LPB between patients treated with Crinone and those treated with IMP (33.2% vs. 25.7%). LPB occurred with equal frequency among pregnant patients in both arms (Crinone 21.9% vs. IMP 18.6%). Only nonpregnant women had a higher incidence of LPB when treated with Crinone compared with treatment with IMP (56.5% vs.38.1%). Estrogen supplementation decreased the occurrence of LPB among all participants but did not impact pregnancy rates. CONCLUSION(S) Only nonpregnant women had a higher incidence of bleeding in the luteal phase when supplemented with Crinone compared with treatment with IMP. IMP delays menses in nonpregnant cycles without affecting pregnancy rates. Luteal estrogen decreases LPB without impacting cycle outcomes.