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Effect of clomiphene citrate treatment on endometrial estrogen and progesterone receptor induction in women

1991; Elsevier BV; Volume: 165; Issue: 1 Linguagem: Inglês

10.1016/0002-9378(91)90247-o

1097-6868

Marc A. Fritz, Ronald T. Holmes, Edward J. Keenan,

Estrogen and related hormone effects

A direct adverse effect of clomiphene citrate on the endometrium has been presumed, and interference with estrogen receptor-mediated endometrial estrogen receptor and progesterone receptor induction has been implicated as the mechanism responsible for an increased incidence of luteal phase deficiency in association with clomiphene citrate treatment. To clarify the net influence of clomiphene administration on endometrial steroid receptor induction, we studied five normal ovulatory women, in both a spontaneous and clomiphene-induced (150 mg /day, cycle days 5 to % ovulatory cycle. From cycle day 11 blood samples were obtained daily and urinary luteinizing hormone determinations were performed twice daily. Endometrial biopsy was performed on the day of the urinary futeinizing hormone surge and again 13 days after the surge. Serum levels of follicle-stimulating hormone and luteinizing hormone were determined by immunoradiometric assay, estradiol and progesterone by radioimmunoassay, and clomiphene citrate isomer concentrations in treatment cycles by reversed-phase high-performance liquid chromatography and fluorescence detection. Total, cytosolic, and salt-extracted nuclear endometrial estrogen receptor and progesterone receptor concentrations were determined by enzyme-linked immunoassay. Serum estradiol was threefold to fivefold higher (p &#x0026;#x0026;#x0026;#x0026;#x0026;#x0026;#x0026;#x0026;#x0026;#x0026;#x0026;#x0026;#x0026;#x0026;#x0026;#x0026;#x003C; 0.05) in clomiphene-induced than in spontaneous cycles 8 and 10 days before the luteinizing hormone surge, and progesterone was increased (p < 0.05) from the day of the surge to end of the cycle. Serum enclomiphene rose to plateau between 12 and 6 days before the luteinizing hormone surge (4.1 ± 0.8 ng/ml, mean ± SE, n = 19) and fell thereafter to <1.0 ng/ml. Zuclomiphene levels increased rapidly between 14 and 8 days before the surge (53.9 ± 2.8 ng/ml, mean ± SE, n = 5) and then decreased gradually but remained elevated throughout the luteal phase (29.0 ± 1.2 ng/ml, mean ± SE, n = 33). Late luteal endometrial histology was abnormal in one of four available treatment cycle specimens, but the endocrine characteristics and number and subcellular distribution of estrogen receptor and progesterone receptor in the abnormal cycle were not different from those of normal, in-phase cycles. Total estrogen receptor and progesterone receptor at midcycle were three to four times higher (p < 0.01) than in the late luteal phase in both spontaneous cycles (7.2 ± 2.3 vs 1.9 ± 0.4 pmol/mg deoxyribonucleic acid estrogen receptor and 41.3 ± 13.9 vs 13.4 ± 3.9 pmol/mg deoxyribonucleic acid progesterone receptor) and clomiphene-induced cycles (8.2 ± 2.3 vs 1.8 ± 0.8 pmol/mg deoxyribonucleic acid estrogen receptor and 40.4 ± 9,9 vs 10.1 ± 4.1 pmol/mg deoxyribonucleic acid progesterone receptor), but neither midcycle nor late luteal estrogen receptor or progesterone receptor in any category (total, cytosolic, or salt-extracted nuclear) differed from spontaneous cycle values. These data strongly suggest that clomiphene citrate treatment does not adversely affect endometrial estrogen receptor and progesterone receptor induction. A direct adverse effect of clomiphene citrate on the endometrium has been presumed, and interference with estrogen receptor-mediated endometrial estrogen receptor and progesterone receptor induction has been implicated as the mechanism responsible for an increased incidence of luteal phase deficiency in association with clomiphene citrate treatment. To clarify the net influence of clomiphene administration on endometrial steroid receptor induction, we studied five normal ovulatory women, in both a spontaneous and clomiphene-induced (150 mg /day, cycle days 5 to % ovulatory cycle. From cycle day 11 blood samples were obtained daily and urinary luteinizing hormone determinations were performed twice daily. Endometrial biopsy was performed on the day of the urinary futeinizing hormone surge and again 13 days after the surge. Serum levels of follicle-stimulating hormone and luteinizing hormone were determined by immunoradiometric assay, estradiol and progesterone by radioimmunoassay, and clomiphene citrate isomer concentrations in treatment cycles by reversed-phase high-performance liquid chromatography and fluorescence detection. Total, cytosolic, and salt-extracted nuclear endometrial estrogen receptor and progesterone receptor concentrations were determined by enzyme-linked immunoassay. Serum estradiol was threefold to fivefold higher (p &#x0026;#x0026;#x0026;#x0026;#x0026;#x0026;#x0026;#x0026;#x0026;#x0026;#x0026;#x0026;#x0026;#x0026;#x0026;#x0026;#x003C; 0.05) in clomiphene-induced than in spontaneous cycles 8 and 10 days before the luteinizing hormone surge, and progesterone was increased (p < 0.05) from the day of the surge to end of the cycle. Serum enclomiphene rose to plateau between 12 and 6 days before the luteinizing hormone surge (4.1 ± 0.8 ng/ml, mean ± SE, n = 19) and fell thereafter to <1.0 ng/ml. Zuclomiphene levels increased rapidly between 14 and 8 days before the surge (53.9 ± 2.8 ng/ml, mean ± SE, n = 5) and then decreased gradually but remained elevated throughout the luteal phase (29.0 ± 1.2 ng/ml, mean ± SE, n = 33). Late luteal endometrial histology was abnormal in one of four available treatment cycle specimens, but the endocrine characteristics and number and subcellular distribution of estrogen receptor and progesterone receptor in the abnormal cycle were not different from those of normal, in-phase cycles. Total estrogen receptor and progesterone receptor at midcycle were three to four times higher (p < 0.01) than in the late luteal phase in both spontaneous cycles (7.2 ± 2.3 vs 1.9 ± 0.4 pmol/mg deoxyribonucleic acid estrogen receptor and 41.3 ± 13.9 vs 13.4 ± 3.9 pmol/mg deoxyribonucleic acid progesterone receptor) and clomiphene-induced cycles (8.2 ± 2.3 vs 1.8 ± 0.8 pmol/mg deoxyribonucleic acid estrogen receptor and 40.4 ± 9,9 vs 10.1 ± 4.1 pmol/mg deoxyribonucleic acid progesterone receptor), but neither midcycle nor late luteal estrogen receptor or progesterone receptor in any category (total, cytosolic, or salt-extracted nuclear) differed from spontaneous cycle values. These data strongly suggest that clomiphene citrate treatment does not adversely affect endometrial estrogen receptor and progesterone receptor induction.