Department of Obstetrics and Gynaecology, The University of Alexandria, 22 Victor Emanuel Square, Smouha, Alexandria, Egypt 21615 e-mail: hnsallam{at}link.net
Dear Sir,
We read with interest the article by Loumaye et al. (2003) in which the authors conclude that recombinant LH (rLH) administered during the late follicular phase can trigger follicular growth arrest in a significant number of patients. In this elegant study, the authors confirm our work presented orally at the ASRM meeting in 1996 and subsequently published in the medical literature (Sallam and Sallam, 1996a
,b).
In our study, we have shown that the administration of HCG during the late follicular phase (day 9) in normally cycling women resulted in defective folliculogenesis as well as luteal phase insufficiency. Ultrasound scanning of ovarian follicles (Sallam et al., 1982; Hackeloer and Sallam, 1983
) showed that the mean day 12 follicular diameter after HCG administration was 15.6 mm compared with 19.1 mm in the control cycles (P < 0.05). Mean day 12 plasma estradiol and day 21 plasma progesterone concentrations were significantly diminished from 282.8 pg/ml to 161.0 pg/ml and from 18.5 ng/ml to 8.7 ng/ml, respectively (P < 0.05; P < 0.05). Similarly, the day 12 cervical mucus score was significantly reduced from 10.9 to 4.4 (P < 0.05). These results have led us to suggest using HCG as a monthly injectable contraceptive.
The work of Loumaye et al. reopens the debate about using HCG or LH as injectable contraceptives. Both compounds have the advantage of being physiological, and much of their effect on the human body is already known. Whether this idea can be safely applied in practice and whether one of the compounds is superior to the other will necessitate properly randomized prospective clinical trials.
References
Hackeloer BJ and Sallam HN (1983) Ultrasound scanning of ovarian follicles. Clin Obstet Gynecol 10,603620.
Loumaye E, Engrand P, Shoham Z, Hillier SG and Baird DT (2003) Clinical evidence for an LH ceiling effect induced by administration of recombinant human LH during the late follicular phase of stimulated cycles in World Health Organization type I and type II anovulation. Hum Reprod 18,314322.
Sallam HN and Sallam AN (1996a) HCG as a monthly injectable contraceptiveeffects of day 9 administration. Fertil Steril Abstract Book Supplement, S58.
Sallam HN and Sallam AN (1996b) Effects of day 9 administration of human chorionic gonadotropin: a possible monthly injectable contraceptive. Middle East Fertil Soc J 1,159163.
Sallam HN, Marinho AO, Collins WP, Rodeck CH and Campbell S (1982) Monitoring gonadotrophin therapy by real-time ultrasonic scanning of ovarian follicles. Br J Obstet Gynecol 89,155159.[Medline]