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Women's Health & Gynecology

JWHG

Aabstract

Research Article

A Sustained Elevated Estradiol is not the Trigger for the Preovulatory Luteinizing Hormone Surge

Bradley S Hurst, Kathryn S Merriam, Mollie Elliot, Michelle L Matthews, Paul B Marshburn, Rebecca S Usadi

Correspondence Address :

Bradley S. Hurst
1025 Medical Center Plaza, Suite 500, Charlotte NC 28204
USA
Tel: 704-355-1747, Fax: 704-355-8798
Email: Brad.Hurst@carolinashealthcare.org

Received on: August 24, 2015, Accepted on: September 23, 2015, Published on: September 29, 2015

Citation: Hurst BS, Merriam KS, Elliot M, Matthews ML, Marshburn PB, Usadi RS (2015). A Sustained Elevated Estradiol is not the Trigger for the Preovulatory Luteinizing Hormone Surge

Copyright: 2015 Bradley S. Hurst, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

  • Abstract

Abstract
Objective: To determine if sustained elevated estradiol (E2) is the primary trigger for the LH surge and subsequent ovulation.
Methods: This was a prospective randomized controlled study at an academic fertility center of ten healthy ovulatory volunteers with regular menstrual cycles 26-30 days. The first cycle was a monitored natural control cycle, and in the second cycle women took letrozole 5 mg daily from cycle day 1-3 through day 22. Both cycles were monitored with daily urinary LH days 10-18, one ultrasound days 12-14, and serum E2 and progesterone days 12, 14, 16, 18, 20, and 22. The normal cycle was assessed first to avoid a potential effect of letrozole in a subsequent cycle.
Results: All 10 women ovulated during the daily letrozole cycle, even though serum E2 was significantly lower than the natural control cycle. Nine of 10 ovulated in the natural cycle.
Conclusions: A sustained physiologic E2 elevation is not the trigger for ovulation, since all women ovulated in cycles when E2 was continuously suppressed by an aromatase inhibitor. Although E2 and progesterone may serve permissive roles, we hypothesize that there is another signal for the LH surge which has not been elucidated.
Clinical Trials Registry Number: NCT01999569 (clinicaltrial.gov)

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