Use of aromatase inhibitors in poor-responder patients receiving GnRH antagonist protocols

Ozmen, Batuhan; Sönmezer, Murat; Atabekoglu, Cem Somer; Olmuş, Hülya

doi:10.1016/j.rbmo.2009.05.007

« Previous Next »Reproductive BioMedicine Online
Volume 19, Issue 4 , Pages 478-485, October 2009

Use of aromatase inhibitors in poor-responder patients receiving GnRH antagonist protocols☆

Batuhan Ozmen
- Center for Research on Human Reproduction, School of Medicine, University of Ankara, Ankara, Turkey
- Department of Obstetrics and Gynecology, School of Medicine, University of Ankara, Ankara, Turkey
- Correspondence:
Murat Sönmezer
- Center for Research on Human Reproduction, School of Medicine, University of Ankara, Ankara, Turkey
- Department of Obstetrics and Gynecology, School of Medicine, University of Ankara, Ankara, Turkey
Cem Somer Atabekoglu
- Center for Research on Human Reproduction, School of Medicine, University of Ankara, Ankara, Turkey
- Department of Obstetrics and Gynecology, School of Medicine, University of Ankara, Ankara, Turkey
Hülya Olmuş
- Department of Statistics, Faculty of Science and Art, University of Gazi, Ankara, Turkey

Received 24 October 2008; received in revised form 12 December 2008; accepted 11 May 2009. published online 02 August 2010.

Declaration: The authors report no financial or commercial conflicts of interest.

Abstract

The efficacy of aromatase inhibitors incorporated in the ovarian stimulation protocols of poor-responder patients undergoing intracytoplasmic sperm injection-embryo transfer cycles was investigated. A total of 70 poor-responder patients were randomized into two groups on day 3 of their menstrual cycle. In Group A, an aromatase inhibitor (letrozole, 5mg/day) was administered along with a fixed dosage (450IU/day) of recombinant FSH (rFSH), whereas Group B were treated with the same rFSH dosage alone. A flexible regimen of gonadotrophin-releasing hormone antagonist was administered in both groups. The mean total dose of rFSH (2980±435IU versus 3850±580IU, P<0.05) and serum concentrations of oestradiol on the day of human chorionic gonadotrophin administration (1870±159 pg/ml versus 2015±175 pg/ml, P<0.05) were significantly lower in Group A compared with Group B, respectively. The rate of cycle cancellation due to poor ovarian response was lower in Group A (8.6%) than in Group B (28.6%), (P<0.05). The costs of achieving a clinical pregnancy were US$11560 and US$17584, and the clinical pregnancy rates per embryo transfer were 25.8% and 20%, in groups A and B, respectively. In conclusion, adjunctive letrozole administration seems to restore an IVF cycle by decreasing the rate of cycle cancellation and seems to reduce the cost by reducing the total gonadotrophin dosage.

Keywords: aromatase inhibitor, cost, GnRH antagonist, ICSI, poor response

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☆ Dr Batuhan Özmen completed his residency programme in obstetrics and gynaecology at University of Ankara in 2003, obtaining his certification in reproductive medicine and artificial reproductive techniques in 2005. In 2006, he worked in the Department of Obstetrics and Gynecology of the University of Schleswig-Holstein in Lübeck under the supervision of Professor Safaa Al-Hasani on laboratory applications in reproductive medicine. He is interested in cryopreservation and vitrification of human gametes, reproductive surgery and human sperm DNA damage. He is now working in the Department of Reproductive Endocrinology at the University of Ankara, Turkey.Dr Batuhan Özmen