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• W2105728531 abstract "To the Editor:Tartagni et al. (1Tartagni M. Cicinelli E. De Pergola G. De Salvia M.A. Lavopa C. Loverro G. Effects of pretreatment with estrogens on ovarian stimulation with gonadotropins in women with premature ovarian failure: a randomized, placebo-controlled trial.Fertil Steril. 2007; 87: 858-861Abstract Full Text Full Text PDF PubMed Scopus (80) Google Scholar) are to be congratulated for the high ovulation rate and pregnancy rate in their premature ovarian failure (POF) patients using pretreatment with estrogen. They have convincingly demonstrated that pretreatment with EE (Etinil-Estradiolo; Amsa, Rome, Italy) improves the success of rate of ovulation induction with exogenous gonadotropins in patients with POF. However, there may another pathophysiologic explanation for the success rate after the endogenous follicle-stimulating hormone (FSH) concentrations have been decreased to below 15 U/L. As we have hypothesized in this journal 14 years ago (2Blumenfeld Z. Halachmi S. Peretz B.A. Shmuel Z. Golan D. Makler A. Brandes J.M. Premature ovarian failure. The prognostic application of autoimmunity on conception after ovulation induction.Fertil Steril. 1993; 59: 750-755Abstract Full Text PDF PubMed Google Scholar), the high menopausal levels of FSH may be inactive (3Hoek A. Schoemaker J. Drexhage H.A. Premature ovarian failure and ovarian autoimmunity.Endocr Rev. 1997; 18: 107-134Crossref PubMed Scopus (390) Google Scholar) but occupy the ovarian FSH receptors, rendering them inaccessible to exogenous, active recombinant FSH. After decreasing the endogenous, inactive concentrations to 15 U/L or even lower, by either EE or GnRH-a, the FSH receptors may be released from their occupancy by the endogenous, inactive ligand, allowing the exogenous recombinant FSH to attach to the unoccupied receptors and activate them (3Hoek A. Schoemaker J. Drexhage H.A. Premature ovarian failure and ovarian autoimmunity.Endocr Rev. 1997; 18: 107-134Crossref PubMed Scopus (390) Google Scholar).In addition, we do not agree with the authors' extrapolation from their success in relatively young women (32 years old) with short-term POF (16 months) to perimenopausal patients. The authors' speculation that “we may assume that similar results could be obtained in women in early postmenopause” is not a deductible conclusion or logical extrapolation. Their 32% success rate in achieving ovulation and 16% pregnancy rate can be achieved in young POF patients usually within a year or two after the diagnosis, but it probably cannot be attained in older perimenopausal women or in those who have been diagnosed as POF for more than a year or two (2Blumenfeld Z. Halachmi S. Peretz B.A. Shmuel Z. Golan D. Makler A. Brandes J.M. Premature ovarian failure. The prognostic application of autoimmunity on conception after ovulation induction.Fertil Steril. 1993; 59: 750-755Abstract Full Text PDF PubMed Google Scholar). As previously suggested (2Blumenfeld Z. Halachmi S. Peretz B.A. Shmuel Z. Golan D. Makler A. Brandes J.M. Premature ovarian failure. The prognostic application of autoimmunity on conception after ovulation induction.Fertil Steril. 1993; 59: 750-755Abstract Full Text PDF PubMed Google Scholar, 3Hoek A. Schoemaker J. Drexhage H.A. Premature ovarian failure and ovarian autoimmunity.Endocr Rev. 1997; 18: 107-134Crossref PubMed Scopus (390) Google Scholar), an autoimmune etiology and young age are good prognostic factors for future fertility despite POF; indeed, the patients in the Tartagni study belong to this category and do not represent the older POF patients without autoimmune activity. To the Editor: Tartagni et al. (1Tartagni M. Cicinelli E. De Pergola G. De Salvia M.A. Lavopa C. Loverro G. Effects of pretreatment with estrogens on ovarian stimulation with gonadotropins in women with premature ovarian failure: a randomized, placebo-controlled trial.Fertil Steril. 2007; 87: 858-861Abstract Full Text Full Text PDF PubMed Scopus (80) Google Scholar) are to be congratulated for the high ovulation rate and pregnancy rate in their premature ovarian failure (POF) patients using pretreatment with estrogen. They have convincingly demonstrated that pretreatment with EE (Etinil-Estradiolo; Amsa, Rome, Italy) improves the success of rate of ovulation induction with exogenous gonadotropins in patients with POF. However, there may another pathophysiologic explanation for the success rate after the endogenous follicle-stimulating hormone (FSH) concentrations have been decreased to below 15 U/L. As we have hypothesized in this journal 14 years ago (2Blumenfeld Z. Halachmi S. Peretz B.A. Shmuel Z. Golan D. Makler A. Brandes J.M. Premature ovarian failure. The prognostic application of autoimmunity on conception after ovulation induction.Fertil Steril. 1993; 59: 750-755Abstract Full Text PDF PubMed Google Scholar), the high menopausal levels of FSH may be inactive (3Hoek A. Schoemaker J. Drexhage H.A. Premature ovarian failure and ovarian autoimmunity.Endocr Rev. 1997; 18: 107-134Crossref PubMed Scopus (390) Google Scholar) but occupy the ovarian FSH receptors, rendering them inaccessible to exogenous, active recombinant FSH. After decreasing the endogenous, inactive concentrations to 15 U/L or even lower, by either EE or GnRH-a, the FSH receptors may be released from their occupancy by the endogenous, inactive ligand, allowing the exogenous recombinant FSH to attach to the unoccupied receptors and activate them (3Hoek A. Schoemaker J. Drexhage H.A. Premature ovarian failure and ovarian autoimmunity.Endocr Rev. 1997; 18: 107-134Crossref PubMed Scopus (390) Google Scholar). In addition, we do not agree with the authors' extrapolation from their success in relatively young women (32 years old) with short-term POF (16 months) to perimenopausal patients. The authors' speculation that “we may assume that similar results could be obtained in women in early postmenopause” is not a deductible conclusion or logical extrapolation. Their 32% success rate in achieving ovulation and 16% pregnancy rate can be achieved in young POF patients usually within a year or two after the diagnosis, but it probably cannot be attained in older perimenopausal women or in those who have been diagnosed as POF for more than a year or two (2Blumenfeld Z. Halachmi S. Peretz B.A. Shmuel Z. Golan D. Makler A. Brandes J.M. Premature ovarian failure. The prognostic application of autoimmunity on conception after ovulation induction.Fertil Steril. 1993; 59: 750-755Abstract Full Text PDF PubMed Google Scholar). As previously suggested (2Blumenfeld Z. Halachmi S. Peretz B.A. Shmuel Z. Golan D. Makler A. Brandes J.M. Premature ovarian failure. The prognostic application of autoimmunity on conception after ovulation induction.Fertil Steril. 1993; 59: 750-755Abstract Full Text PDF PubMed Google Scholar, 3Hoek A. Schoemaker J. Drexhage H.A. Premature ovarian failure and ovarian autoimmunity.Endocr Rev. 1997; 18: 107-134Crossref PubMed Scopus (390) Google Scholar), an autoimmune etiology and young age are good prognostic factors for future fertility despite POF; indeed, the patients in the Tartagni study belong to this category and do not represent the older POF patients without autoimmune activity. Letter to the EditorFertility and SterilityVol. 88Issue 3PreviewReply of the Author: Full-Text PDF" @default.
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• W2105728531 title "Pregnancies in patients with POF gonadotropin stimulation and pretreatment with ethinyl estradiol" @default.
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