Aromatase inhibitor co-treatment with gonadotropin reduces the dose of gonadotropn and peak estradiol level without compromising IVF outcomes in high responder patients

Aim: To determine if the properly timed, combined used of Letrozole, Cabergoline and GnRH antagonist eliminate the occurrence of ovarian hyper stimulation syndrome (OHSS) in polycystic ovarian syndrome (PCOS)? Study Design: We compared the severity of OHSS after using a new treatment with the severity of OHSS in a group of PCOS patients who received the GnRH antagonist-GnRH agonist-based controlled ovarian stimulation (COS) in retrospective cohort study between August 2019 and December 2021. Materials and Methods: 53 PCOS patients received the new treatment were compared to 32 PCOS patients treated with conventional methods. 5mg of Letrozole, 0.5mg of Cabergoline and 0.25mg of GnRH antagonist were administered from just after the oocyte pick up (OPU) for five consecutive days. Results: There were no significant differences in the clinical pregnancy rate, cumulative pregnancy rate and cumulative live birth rate between the two COS. The number of days between OPU and menstruation start in the novel COS was significantly lower than that of the conventional one (5.26+2.59 vs. 17.62+5.75). This treatment produced no incidences of OHSS, compared to 21.9% of all cases having mild OHSS with the conventional method. Conclusion:We found that administering Letrozole, Cabergoline and GnRH antagonist for five days consecutively after OPU effective for the complete prevention of OHSS.

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“…The idea of combining these drugs aiming at a synergetic effect for preventing OHSS was derived from four reports [16][17][18][19] . H.S.…”

Section: Discussionmentioning

confidence: 99%

“…H.S. Lee reported that Letrozole has effects to reduce the E2 level without lower the quality of oocyte in GnRH antagonist base COS resulted in decreased risk of OHSS [18] . Y. Chen reported letrozole administration before the trigger shot of HCG in PCOS women lower the E2 level and incidence of OHSS due to luteolysis [16] .…”

Section: Discussionmentioning

confidence: 99%

Combined use of Letrozole, Cabergoline and GnRH antagonist Eliminates Ovarian Hyperstimulation Syndrome (OHSS) in Polycystic Ovarian Syndrome (PCOS)

Yanagihara¹,

Tanaka²,

Nagayoshi³

et al. 2022

Evidence Based Women's Health Journal

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“…The idea of this combination of drugs aiming at a synergetic effect for preventing OHSS was derived from four reports. 15 , 16 , 25 , 26 In 2013, H.S. Lee reported that aromatase inhibitor co‐treatment with gonadotropin ovarian stimulation reduces peak E2 level without compromising IVF outcomes in high responder patients.…”

Section: Discussionmentioning

confidence: 99%

“…The idea of this combination of drugs aiming at a synergetic effect for preventing OHSS was derived from four reports 15,16,25,26 . In 2013, H.S.…”

Section: Discussionmentioning

confidence: 99%

“…Lee reported that aromatase inhibitor co‐treatment with gonadotropin ovarian stimulation reduces peak E2 level without compromising IVF outcomes in high responder patients. In addition, the incidence of severe OHSS was apparently lower when letrozole was used 25 . Y. Chen reported in 2018 a retrospective study of letrozole treatment prior to human chorionic gonadotropin in PCOS patients and explained the mechanism of lowering the E2 level due to luteolysis 15 .…”

Section: Discussionmentioning

confidence: 99%

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A modified GnRH antagonist method in combination with letrozole, cabergoline, and GnRH antagonist for PCOS: Safe and effective ovarian stimulation to treat PCOS and prevent OHSS

Yanagihara

Tanaka

Nagayoshi³

et al. 2021

Reprod Medicine & Biology

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Purpose To analyze the therapeutic efficacy of a modified controlled ovarian stimulation (COS) protocol for polycystic ovary syndrome (PCOS) that does not cause ovarian hyperstimulation syndrome (OHSS) while maintaining oocyte quality. Method This study is a retrospective cohort study of reproductive medicine at St. Mother Clinic. We analyzed ART clinical outcomes, embryonic development, and hormone levels in 175 PCOS patients treated with four COS (GnRH agonist based long protocol, Group A; GnRH antagonist protocol with HCG trigger, Group B; GnRH antagonist protocol with GnRH agonist trigger, Group C, and the modified COS group) between 2010 and 2021. Results Of 175 patients with PCOS, 45 and 130 patients underwent 47 and 136 oocyte retrieval cycles, 75 and 250 embryo transfer cycles with the modified COS, and with conventional methods, respectively. The cumulative pregnancy rate at one trial was a significantly higher result than in Group A and higher than in Groups B and C (cumulative pregnancy rate at one trial of Group A, B, C, and modified COS: 40.0%, 54.5%, 56.3%, and 72.3%, respectively). With this method, not clinically problematic OHSS and higher clinical outcomes than in conventional methods were observed. Conclusion This modified COS can significantly improve clinical outcomes and eliminate OHSS.

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Aromatase inhibitor co-treatment with gonadotropin reduces the dose of gonadotropn and peak estradiol level without compromising IVF outcomes in high responder patients

Cited by 2 publications

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Combined use of Letrozole, Cabergoline and GnRH antagonist Eliminates Ovarian Hyperstimulation Syndrome (OHSS) in Polycystic Ovarian Syndrome (PCOS)

Combined use of Letrozole, Cabergoline and GnRH antagonist Eliminates Ovarian Hyperstimulation Syndrome (OHSS) in Polycystic Ovarian Syndrome (PCOS)

A modified GnRH antagonist method in combination with letrozole, cabergoline, and GnRH antagonist for PCOS: Safe and effective ovarian stimulation to treat PCOS and prevent OHSS

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