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Ovulation induction and controlled ovarian stimulation using letrozole gonadotropin combination: A single center retrospective cohort study.
Eur J Obstet Gynecol Reprod Biol. 2017 Nov; 218:123-128.EJ

Abstract

OBJECTIVE

To assess the effect of letrozole in combination with low dose gonadotropins for ovulation induction in anovulatory infertility from polycystic ovary syndrome (PCOS) and controlled ovarian stimulation for endometriosis, and unexplained infertility patients.

STUDY DESIGN

Retrospective cohort study in a setting of private Reproductive Endocrinology and Infertility Clinic affiliated with the University. Three hundred couples (650 cycles) requiring OI/COS for PCOS (92 patients, 195 cycles), endometriosis (89 patients, 217 cycles), and unexplained infertility (119 patients, 238 cycles). Patients received 2.5mg or 5mg letrozole for 5days (D3-D7) and recombinant follicle-stimulating hormone on alternating D3-D7 and human menopausal gonadotropin-highly purified alternating D5-D10 until growth of ideally 2 mature follicles. Ovulation was triggered with 10,000 IU of HCG. Maximum number of cycles per patient was four.

RESULTS

Main outcome measures were clinical pregnancy rates, multiple order pregnancy rates, miscarriage rates, number of follicles and endometrial thickness on the day of HCG administration. The cumulative incidence of pregnancy was estimated as 35% (95%CI: 29%-41%) overall and was highest in patients with PCOS (36.6%), followed by unexplained infertility (34.6%) and endometriosis (32.5%). The pregnancy rates per cycle in PCOS, endometriosis and unexplained infertility patients were 17%, 13.2% and 17.2% respectively, no statistically significant difference between the groups. There were three twin pregnancies in PCOS, and one in unexplained infertility group. Monofolliculogenesis was noted in 48% of patients.

CONCLUSION(S)

Letrozole-low dose gonadotropins combination appears to be effective across different causes of infertility for superovulation. The letrozole-low dose gonadotropin combination resulted in high rate of monofolliculogenesis, low occurrence of multiple gestations and no case of OHSS or cycle cancellation.

Authors+Show Affiliations

Department of Obstetrics and Gynecology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, 4801 Alberta Ave, El Paso, TX, 79905, USA. Electronic address: sushila.arya@ttuhsc.edu.Department of Obstetrics and Gynecology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, 5001 El Paso Drive, El Paso, TX, 79905, USA. Electronic address: sanja.kupesic@ttuhsc.edu.Department of Obstetrics and Gynecology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, 5001 El Paso Drive, El Paso, TX, 79905, USA. Electronic address: zuber.mulla@ttuhsc.edu.Department of Biomedical Sciences, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, 5001 El Paso Drive, El Paso, TX, 79905, USA. Electronic address: alokkumardwivedi@gmail.com.Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, 5001 El Paso Drive, El Paso, TX, 79905, USA.Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, 5001 El Paso Drive, El Paso, TX, 79905, USA.Reproductive Endocrinology and Infertility, Southwest Center for Reproductive Health, 700 S Mesa Hills Dr., El Paso, TX, 79912, USA. Electronic address: lsnoble@elp.rr.com.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28985546

Citation

Arya, Sushila, et al. "Ovulation Induction and Controlled Ovarian Stimulation Using Letrozole Gonadotropin Combination: a Single Center Retrospective Cohort Study." European Journal of Obstetrics, Gynecology, and Reproductive Biology, vol. 218, 2017, pp. 123-128.
Arya S, Kupesic-Plavsic S, Mulla ZD, et al. Ovulation induction and controlled ovarian stimulation using letrozole gonadotropin combination: A single center retrospective cohort study. Eur J Obstet Gynecol Reprod Biol. 2017;218:123-128.
Arya, S., Kupesic-Plavsic, S., Mulla, Z. D., Dwivedi, A. K., Crisp, Z., Jose, J., & Noble, L. S. (2017). Ovulation induction and controlled ovarian stimulation using letrozole gonadotropin combination: A single center retrospective cohort study. European Journal of Obstetrics, Gynecology, and Reproductive Biology, 218, 123-128. https://doi.org/10.1016/j.ejogrb.2017.09.023
Arya S, et al. Ovulation Induction and Controlled Ovarian Stimulation Using Letrozole Gonadotropin Combination: a Single Center Retrospective Cohort Study. Eur J Obstet Gynecol Reprod Biol. 2017;218:123-128. PubMed PMID: 28985546.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Ovulation induction and controlled ovarian stimulation using letrozole gonadotropin combination: A single center retrospective cohort study. AU - Arya,Sushila, AU - Kupesic-Plavsic,Sanja, AU - Mulla,Zuber D, AU - Dwivedi,Alok K, AU - Crisp,Zeni, AU - Jose,Jisha, AU - Noble,Luis S, Y1 - 2017/09/23/ PY - 2017/04/03/received PY - 2017/09/12/revised PY - 2017/09/22/accepted PY - 2017/10/7/pubmed PY - 2018/6/12/medline PY - 2017/10/7/entrez KW - Combined letrozole-gonadotropin KW - Controlled ovarian stimulation KW - Gonadotropins KW - Letrozole KW - Ovulation induction SP - 123 EP - 128 JF - European journal of obstetrics, gynecology, and reproductive biology JO - Eur. J. Obstet. Gynecol. Reprod. Biol. VL - 218 N2 - OBJECTIVE: To assess the effect of letrozole in combination with low dose gonadotropins for ovulation induction in anovulatory infertility from polycystic ovary syndrome (PCOS) and controlled ovarian stimulation for endometriosis, and unexplained infertility patients. STUDY DESIGN: Retrospective cohort study in a setting of private Reproductive Endocrinology and Infertility Clinic affiliated with the University. Three hundred couples (650 cycles) requiring OI/COS for PCOS (92 patients, 195 cycles), endometriosis (89 patients, 217 cycles), and unexplained infertility (119 patients, 238 cycles). Patients received 2.5mg or 5mg letrozole for 5days (D3-D7) and recombinant follicle-stimulating hormone on alternating D3-D7 and human menopausal gonadotropin-highly purified alternating D5-D10 until growth of ideally 2 mature follicles. Ovulation was triggered with 10,000 IU of HCG. Maximum number of cycles per patient was four. RESULTS: Main outcome measures were clinical pregnancy rates, multiple order pregnancy rates, miscarriage rates, number of follicles and endometrial thickness on the day of HCG administration. The cumulative incidence of pregnancy was estimated as 35% (95%CI: 29%-41%) overall and was highest in patients with PCOS (36.6%), followed by unexplained infertility (34.6%) and endometriosis (32.5%). The pregnancy rates per cycle in PCOS, endometriosis and unexplained infertility patients were 17%, 13.2% and 17.2% respectively, no statistically significant difference between the groups. There were three twin pregnancies in PCOS, and one in unexplained infertility group. Monofolliculogenesis was noted in 48% of patients. CONCLUSION(S): Letrozole-low dose gonadotropins combination appears to be effective across different causes of infertility for superovulation. The letrozole-low dose gonadotropin combination resulted in high rate of monofolliculogenesis, low occurrence of multiple gestations and no case of OHSS or cycle cancellation. SN - 1872-7654 UR - https://www.unboundmedicine.com/medline/citation/28985546/Ovulation_induction_and_controlled_ovarian_stimulation_using_letrozole_gonadotropin_combination:_A_single_center_retrospective_cohort_study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0301-2115(17)30458-X DB - PRIME DP - Unbound Medicine ER -