GnRH ANTAGONIST AND LETROZOLE CO-TREATMENT IN NORMAL OVARIAN RESERVE PATIENTS

Abstract

To investigate the clinical value of letrozole in IVF-ET for normal ovarian reserve patients who were treated using GnRH antagonist protocol. A retrospective study. Patients underwent firs or second IVF-ET cycle, with age between 22-38 years old, AMH between 1.1-3.6ng/ml, FSH<10U/L, AFC>6, were involved. The 867 cycles were analyzed. All the cycles were divided into 2 groups based on whether use letrozole 5 mg qd*5 in GnRH antagonist protocol: cycles with letrozole (Group A, n=462), cycles without letrozole (Group B, n=405). We compared the basic status of patients and clinical outcomes of the 2 groups. There were no significantly differences found in age, BMI, AMH, and basal FSH between 2 groups, Group A had significantly lower Gn doses, E2 levels on trigger day, numbers oocytes retrieved, higher rate of LH increase and progesterone advance. Most importantly, Group A had significantly lower rate of oocyte maturation, 2PN fertilization, high quality embryo, clinical pregnancy. But positive aspects is that Group A had lower OHSS incidence rate (1.93% vs 4.44%). Combination of letrozole in antagonist protocal for patients with normal ovarian reserve may have adverse effects on pregnancy rate, oocyte maturation and fertilization. Positive effects are to reduce Gn usage and OHSS incidence.Tabled 1Group A (n=462)Group B(n=405)P valuesAge (year)35.010 ± 5.16834.610 ± 2.9800.710BMI23.128 ± 3.16622.997 ± 3.0850.082Basal FSH (U/L)6.764 ± 1.4616.685 ± 1.2840.553AMH (ng/ml)3.757 ± 3.6083.807 ± 0.5390.241Gn days8.640 ± 1.6728.820 ± 1.6230.164Gn doses1735.673 ± 607.8551880.786 ± 615.408<0.001Em thickness (mm)9.988 ± 2.18711.041 ± 2.114<0.001E2 on HCG day (pg/ml)738.061 ± 478.8242196.872 ± 1065.920<0.001LH on HCG day (U/L)4.517 ± 3.5023.130 ± 2.354<0.001P4 on HCG day (ng/ml)0.625 ± 0.3220.671 ± 0.3220.094No. retrieved oocytes8.250 ± 4.12510.470 ± 4.386<0.001progesterone advance rate on trigger day (≥1.5pg/ml)%11.69 (54/462)7.16 (29/405)0.024LH increased rate on trigger day (>10U/L)%9.96 (46/462)3.95 (16/405)0.001oocyte maturation rate (ICSI)%64.30 (913/1420)73.64 (1084/1472)0.0002PN fertilization rate (%)52.63 (2004/3808)59.23 (2657/4486)0.000available embryo rate (%)76.40 (1531/2004)77.00 (2046/2657)0.627high quality embryo rate (%)78.12 (1196/1531)81.48 (1667/2046)0.013embryo transplant ratio (%)38.74 (179/462)44.69 (181/405)0.076Clinical pregnancy rate (%)35.75 (64/179)46.96 (85/181)0.031Miscarried rate (%)16.13 (10/62)19.75 (16/81)0.578ectopic pregnancy rate (%)3.13 (2/64)4.71 (4/85)0.627incidence of moderate and severe OHSS1.95 (9/462)4.44 (18/405)0.035 Open table in a new tab