RESUMO
The metabolic and hemostatic effects of two oral contraceptives containing 150 mcg desogestrel and 20 mcg ethinyl-estradiol (EE) (MERCILON) or 30 mcg EE (MARVELON) were compared in order to examine the effect of reducing the EE dose in contraceptive pills. Forty-nine women participated in this randomized study during 6 cycles. In both groups, there was a significant increase in triglycerides, HDL-cholesterol and apoprotein A1; the same increase was observed for SBP and CBG. Slight and transient variations of fasting blood glucose levels were seen in the 30 mcg EE group and in the two groups for fasting insulin levels. The increase in renin substrate was significantly higher with the 30 mcg EE than with the 20 mcg EE pill. In both groups, plasminogen increased significantly, but antithrombin III, total and free protein S and fibrinogen decreased significantly only in women taking the 30 mcg EE pill, whereas there was no significant change in the 20 mcg EE group. Reducing the dose of EE in oral contraceptives from 30 mcg to 20 mcg minimizes their impact on renin substrate and hemostatic parameters.
Assuntos
Anticoncepcionais Orais Hormonais/administração & dosagem , Desogestrel/administração & dosagem , Desogestrel/farmacologia , Etinilestradiol/administração & dosagem , Hemostasia/efeitos dos fármacos , Pancurônio/análogos & derivados , Apolipoproteína A-I/metabolismo , HDL-Colesterol/sangue , Anticoncepcionais Orais Hormonais/farmacologia , Relação Dose-Resposta a Droga , Etinilestradiol/farmacologia , Feminino , Humanos , Pancurônio/farmacologia , Plasminogênio/metabolismo , Estudos Prospectivos , Proteína C/metabolismo , Proteína S/sangue , Renina/sangue , Globulina de Ligação a Hormônio Sexual/metabolismo , Transcortina/metabolismo , Triglicerídeos/sangueRESUMO
The necessity of luteal-phase supplementation in an IVF programme is of continuing interest. After ovarian stimulation with clomiphene and human menopausal gonadotrophin (HMG), the beneficial effect of supporting the luteal phase has never been scientifically demonstrated. After ovarian stimulation with GnRH agonist/HMG, the luteal phase seems to be inadequate, but in a previous study we did not find evidence to support the need for oral progesterone supplementation. To evaluate the beneficial effect of human chorionic gonadotrophin (HCG) supplementation, we performed a multicentre, double-blind, randomized study with HCG (193 transfers) against placebo (194 transfers). The ongoing pregnancy rate per transfer cycle was significantly better with HCG (18.7 versus 9.3). This is the first truly objective (randomized) study demonstrating the beneficial effect of supporting the luteal phase in an IVF programme.
