Abstract
BackgroundFor the last year we have been treating normal responders with gonadotropins and letrozole during the whole stimulation in order to improve response to FSH by increasing the intrafollicular androgen concentration, and to reduce circulating estrogen concentrations. The aim of this study was to compare the IVF outcome of normal responders treated with letrozole and gonadotropins during ovarian stimulation with patients treated with gonadotropins only.MethodsA single centre retrospective cohort study of 174 patients (87 in each group).ResultsThe age of the patients was comparable between the groups. Estradiol levels were significantly higher in the control group (6760 pmol/L vs. 2420 pmol/L respectively, p < 0.01), and the number of follicles ≥15 mm at the trigger day was significantly lower in the control group (7.9 vs. 10, p = 0.02). The number of retrieved oocytes (10 vs. 14.5, p < 0.01), MII oocytes (7.9 vs. 11.2, p < 0.01) and blastocysts (2.7 vs. 4.0, p = 0.02) was significantly higher in the study group. We found no significant differences in the cumulative pregnancy outcome between the two groups (65.2% vs 58.3% p = NS).ConclusionsWe conclude that co-treatment with letrozole improves the IVF outcome in normal responders in terms of increased number of blastocysts obtained without increasing the pregnancy rate or the risk of OHSS.
Highlights
For the last year we have been treating normal responders with gonadotropins and letrozole during the whole stimulation in order to improve response to Follicle stimulating hormone (FSH) by increasing the intrafollicular androgen concentration, and to reduce circulating estrogen concentrations
Lazer et al [5] in a retrospective study, compared poor responders treated with letrozole and low dose gonadotropins vs. poor responders treated with only high dose gonadotropins during in-vitro fertilisation (IVF) cycles
The infertility diagnosis, FSH levels, previous number of IVF treatments, age of the patients and the total dose of gonadotropins were comparable between the two groups (Table 1)
Summary
For the last year we have been treating normal responders with gonadotropins and letrozole during the whole stimulation in order to improve response to FSH by increasing the intrafollicular androgen concentration, and to reduce circulating estrogen concentrations. Lazer et al [5] in a retrospective study, compared poor responders treated with letrozole and low dose gonadotropins vs poor responders treated with only high dose gonadotropins during IVF cycles They found a higher clinical pregnancy rate and a higher live birth rate in the group of patients treated with letrozole and low dose gonadotropins. Garcia-Velasco et al [6] found improved IVF cycle outcome in poor responder patients treated with high dose gonadotropins and letrozole compared to patients treated only with high dose gonadotropins They documented a significant increase in follicular fluid testosterone and androstenedione with letrozole administration for 5 days in the early follicular phase during IVF ovarian stimulation (6)
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