Abstract
Hypothesis/aims of study. The management of poor responders to ovarian stimulation for in vitro fertilization (IVF) has always been a challenge. It is difficult for both doctors and patients to make decision to proceed to oocyte donation or abandon fertility treatment. More predictors of successful IVF treatment in poor responders are needed. The aim of this study was to assess hormonal ovarian function in poor responders undergoing ovarian stimulation and to identify predictors of the chance of clinical pregnancy after IVF cycle.
 Study design, materials and methods. The study included 45 infertile patients undergoing ovarian stimulation with poor ovarian response according to the Bologna criteria. All patients underwent standard IVF or IVF/ICSI protocol using gonadotropin releasing hormone antagonists. Letrozole (5 mg/day) was administered during the first 5 days of stimulation in standard antagonist FSH/hMG protocol to 13 of the patients included in the study, with standard antagonist FSH/hMG protocol being only administered to other 32 patients. Serum and follicular fluid were collected at the time of follicle aspiration, and the concentrations of total testosterone, estradiol and androstenedione were determined.
 Results. Follicular fluid concentrations of testosterone and androstenedione were higher and serum estradiol level was lower in the letrozole group. The serum concentrations of testosterone and androstenedione were comparable in both groups, while the serum estradiol/testosterone ratio was lower in the letrozole group. The threshold level of estradiol/testosterone ratio 1000 on the day of oocyte retrieval above which pregnancy and implantation rates were increased was 1532.68 (odds ratio 7.0 (95% CI 1.3935.35), р = 0.02).
 Conclusion. Evaluating of the serum estradiol / testosterone ratio has been shown to determine aromatase activity of ovarian preovulatory follicles and to predict IVF outcome in poor responders undergoing assisted reproductive technology.
Highlights
Летрозол в дозе 5 мг/день назначали наряду с гонадотропинами в течение первых 5 дней стимуляции 13 пациенткам из числа включенных в исследование
Follicular fluid concentrations of testosterone and androstenedione were higher and serum estradiol level was lower in the letrozole group
The serum concentrations of testosterone and androstenedione were comparable in both groups, while the serum estradiol/testosterone ratio was lower in the letrozole group
Summary
Цель — оценить гормональную функцию яичников в программе ЭКО или ЭКО/ИКСИ у пациенток с прогнозируемым слабым ответом на стимуляцию при проведении контролируемой стимуляции суперовуляции на фоне применения ингибиторов ароматазы для выявления предиктора наступления беременности в цикле ЭКО. В группе пациенток, получавших в протоколе стимуляции наряду с гонадотропинами летрозол, уровни тестостерона и андростендиона в фолликулярной жидкости были выше, а эстрадиола в сыворотке крови в день трансвагинальной пункции — ниже. Соотношение эстрадиол/тестостерон в сыворотке крови в день трансвагинальной пункции было достоверно ниже в группе пациенток, получавших ингибиторы ароматазы. Соотношение эстрадиол/тестостерон в сыворотке крови в день трансвагинальной пункции отражает ароматазную активность преовуляторных фолликулов и обладает предиктивным значением в отношении эффективности лечения в циклах ЭКО у пациенток со слабым овариальным ответом на стимуляцию
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