Minimal stimulation protocol using letrozole versus microdose flare up GnRH agonist protocol in women with poor ovarian response undergoing ICSI

Mohsen, Iman Abdel; Din, Rasha Ezz El

doi:10.3109/09513590.2012.730569

Cited by 47 publications

(11 citation statements)

References 30 publications

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“…In the current study, the number of cancelled cycles in group AL was 2.87 times more than group MF. Despite our study, in the study of Mohsen and El Din, there were no significant statistical difference in the number of oocyte and proper fetus and the number of cancelled cycles between two methods of MF and AL ( Mohsen IA et al, 2013 ). Moreover, in the study of Yarali et al the number of ripe oocyte were significantly higher in MF group, while in their study no significant statistical difference was observed in the number of cancelled cycles between two methods of MF and AL in poor ovarian responders (POR) ( Yarali et al, 2009 ).…”

Section: Discussioncontrasting

confidence: 73%

Comparison of GnRh Agonist Microdose Flare Up and GnRh Antagonist/Letrozole in Treatment of Poor Responder Patients in Intra Cytoplaspic Sperm Injection: Randomized Clinical Trial

Nabati¹,

Peivandi²,

Khalilian³

et al. 2015

GJHS

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Backgrounds:the prevalence of infertility is up to 10 to 15 % which 9 to 24 % of them are Poor Ovarian Responders (POR). This study was designed to compare two methods of GnRH Agonist Microdose Flareup (MF) and GnRH Antagonist/Letrozole (AL) in treatment of these patients.Methods and Materials:this randomized clinical trial study consisted of 123 patients. In the first step of treatment in both methods FSH, LH, estradiol, anderostandion, testestron in third day of menstruation period and the thickness of endometrium by Transvaginal sonography were evaluated. At the time of HCG injection the thickness of endometrium and follicles which were more than 14mm ware established and hormones were evaluated. Two weeks later serum βhCG and after 6 to 8 weeks Transvaginal sonography were applied to prove the pregnancy.Results:there were 61 patients with mean age of 38.7±4.58 in MF group and 62 patients with mean age of 38.5±4.6 in AL group (P=0.80). At the time of hCG injection there were significant increase in the level of LH, estradiol, thickness of endometrium and follicles more than 14mm in MF patients (P<0.0001). The mean time of ovary stimulation in MF group was 10.72±1.5 and in AL was 8.45±1.2 (P<0.0001). The mean level of gonadotropin which were used was 80.6±20.1 in MF patients and 64.7±16.4 in AL group (P<0.0001). 18 % of MF group and 38.7% in AL group had no normal cycle of ovulation (OR: 2.87, 95% CI: 1.25-6.57, P=0.011). The mean numbers of oocyte and normal fetus in MF was 5.83±3.5 and 3.7±2.5 and in AL was 3±1.69 and 1.4±1.33 (P<0.0001). The number of chemical pregnancy in MF group was 10 (16.4%) and in AL was 3 (4.8%) (OR 3.85, 95% CI: 1.06-14.77, P=0.037). Clinical pregnancy in 10 patients (16.4%) of MF group and 3 (4.8%)in AL was reported. OR 3.85, 95% CI: 1.06-14.77, P=0.037).Conclusion:this study showed that MF method of pregnancy leads to more positive results in pregnancy based on chemical and clinical evaluation in comparison with AL and is advised for poor responder patients.

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Section: Discussioncontrasting

confidence: 73%

Comparison of GnRh Agonist Microdose Flare Up and GnRh Antagonist/Letrozole in Treatment of Poor Responder Patients in Intra Cytoplaspic Sperm Injection: Randomized Clinical Trial

Nabati¹,

Peivandi²,

Khalilian³

et al. 2015

GJHS

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“…The results of the two trials with respect to pregnancy rate were totally discordant. Daval (2010)[33] had lower implantation and pregnancy rate in letrozole group, whereas Mohsen and EI Din[34] had similar results between the two groups.…”

Section: Letrozole In Ovarian Stimulation For Ivf/icsimentioning

confidence: 99%

Current evidence supporting "letrozole" for ovulation induction

Kar

2013

J Hum Reprod Sci

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Aromatase inhibitor “letrozole” was first introduced as a potential ovulation induction (OI) drug almost a decade back. Large number of studies has been published using letrozole for OI: In polycystic ovary syndrome (PCOS) women, clomiphene citrate (CC) resistant women, for intrauterine insemination and also in various protocols of mild stimulation for in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI). Letrozole appears to be a good option, with its oral route of administration, cost, shorter half-life and negligible side effects. However, the verdict on efficacy and safety of letrozole is still uncertain. This review explores the current scientific data supporting letrozole for OI.

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“…Mohsen and El Din [ 23 ] showed no difference in clinical pregnancy rates in poor responders when comparing a GnRHa microflare protocol to a letrozole antagonist protocol; however the days of stimulation and total dose of gonadotropins were significantly lower in the letrozole group. Yarali et al [ 9 ] also studied a microdose GnRH agonist protocol versus a letrozole antagonist protocol in poor responders.…”

Section: Discussionmentioning

confidence: 99%

Comparison of IVF Outcomes between Minimal Stimulation and High-Dose Stimulation for Patients with Poor Ovarian Reserve

Lazer

Dar

Shlush

et al. 2014

International Journal of Reproductive Medicine

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We examined whether treatment with minimum-dose stimulation (MS) protocol enhances clinical pregnancy rates compared to high-dose stimulation (HS) protocol. A retrospective cohort study was performed comparing IVF and pregnancy outcomes between MS and HS gonadotropin-antagonist protocol for patients with poor ovarian reserve (POR). Inclusion criteria included patients with an anti-Müllerian hormone (AMH) ≤8 pmol/L and/or antral follicle count (AFC) ≤5 on days 2-3 of the cycle. Patients from 2008 exclusively had a HS protocol treatment, while patients in 2010 had treatment with a MS protocol exclusively. The MS protocol involved letrozole at 2.5 mg over 5 days, starting from day 2, overlapping with gonadotropins, starting from the third day of letrozole at 150 units daily. GnRH antagonist was introduced once one or more follicles reached 14 mm or larger. The HS group received gonadotropins (≥300 IU/day) throughout their antagonist cycle. Clinical pregnancy rate was significantly higher in the MS protocol compared to the HS protocol (P = 0.007). Furthermore, the live birth rate was significantly higher in the MS group compare to the HS group (P = 0.034). In conclusion, the MS IVF protocol is less expensive (lower gonadotropin dosage) and resulted in a higher clinical pregnancy rate and live birth rate than a HS protocol for poor responders.

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Minimal stimulation protocol using letrozole versus microdose flare up GnRH agonist protocol in women with poor ovarian response undergoing ICSI

Abstract: The letrozole/antagonist protocol is a cost-effective and patient-friendly protocol that may be used in poor ovarian responders for IVF/ICSI.

Cited by 47 publications

References 30 publications

Comparison of GnRh Agonist Microdose Flare Up and GnRh Antagonist/Letrozole in Treatment of Poor Responder Patients in Intra Cytoplaspic Sperm Injection: Randomized Clinical Trial

Comparison of GnRh Agonist Microdose Flare Up and GnRh Antagonist/Letrozole in Treatment of Poor Responder Patients in Intra Cytoplaspic Sperm Injection: Randomized Clinical Trial

Current evidence supporting "letrozole" for ovulation induction

Comparison of IVF Outcomes between Minimal Stimulation and High-Dose Stimulation for Patients with Poor Ovarian Reserve

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