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Article: Sequential use of letrozole and gonadotrophin in women with poor ovarian reserve: a randomized controlled trial

TitleSequential use of letrozole and gonadotrophin in women with poor ovarian reserve: a randomized controlled trial
Authors
Issue Date2011
PublisherElsevier Ltd. The Journal's web site is located at http://www.elsevier.com/wps/find/journaldescription.cws_home/721149/description#description
Citation
Reproductive BioMedicine Online, 2011, v. 23 n. 3, p. 380-388 How to Cite?
AbstractSequential use of letrozole and human menopausal gonadotrophin (HMG) was compared with HMG only in poor ovarian responders undergoing IVF. Patients (n=53) with less than four oocytes retrieved in previous IVF cycles or less than five antral follicles were randomized to either letrozole for 5days followed by HMG or HMG alone. The letrozole group had lower dosage of HMG (P<0.001), shorter duration of HMG (P<0.001) and fewer oocytes (P=0.001) when compared with controls. Live-birth rate was comparable with a lower miscarriage rate in the letrozole group (P=0.038). Serum FSH concentrations were comparable in both groups except on day 8, while oestradiol concentrations were all lower in the letrozole group from day 4 (all P<0.001). Follicular fluid concentrations of testosterone, androstenedione, FSH and anti-Mullerian hormone were higher in the letrozole group (P=0.009, P=0.001, P=0.046 and P=0.034, respectively). Compared with HMG alone, sequential use of letrozole and HMG in poor responders resulted in significantly lower total dosage and shorter duration of HMG, a comparable live-birth rate, a significantly lower miscarriage rate and a more favourable hormonal environment of follicular fluid. The management of poor ovarian responders or women with poor ovarian reserve in IVF is controversial. The use of letrozole has been studied; however, results are inconsistent. This randomized trial studied the sequential use of letrozole and gonadotrophin compared with gonadotrophin alone in poor responders undergoing IVF. The sequential use of letrozole and gonadotrophin led to a significantly lower dosage and shorter duration of gonadotrophin use, significantly fewer oocytes, comparable live-birth rate, a significantly lower miscarriage rate and a more favourable hormonal environment at a lower cost.
Persistent Identifierhttp://hdl.handle.net/10722/152946
ISSN
2015 Impact Factor: 2.796
2015 SCImago Journal Rankings: 1.459
ISI Accession Number ID
Funding AgencyGrant Number
Hong Kong OG Trust
Funding Information:

This study was supported by the Hong Kong OG Trust Fund. The authors thank all women who participated in this study and Ms Jane Chan for the co-ordination of the study.

References

 

DC FieldValueLanguage
dc.contributor.authorLee, VCYen_HK
dc.contributor.authorChan, CCWen_HK
dc.contributor.authorNg, EHYen_HK
dc.contributor.authorYeung, WSBen_HK
dc.contributor.authorHo, PCen_HK
dc.date.accessioned2012-07-16T09:52:55Z-
dc.date.available2012-07-16T09:52:55Z-
dc.date.issued2011en_HK
dc.identifier.citationReproductive BioMedicine Online, 2011, v. 23 n. 3, p. 380-388en_HK
dc.identifier.issn1472-6483en_HK
dc.identifier.urihttp://hdl.handle.net/10722/152946-
dc.description.abstractSequential use of letrozole and human menopausal gonadotrophin (HMG) was compared with HMG only in poor ovarian responders undergoing IVF. Patients (n=53) with less than four oocytes retrieved in previous IVF cycles or less than five antral follicles were randomized to either letrozole for 5days followed by HMG or HMG alone. The letrozole group had lower dosage of HMG (P<0.001), shorter duration of HMG (P<0.001) and fewer oocytes (P=0.001) when compared with controls. Live-birth rate was comparable with a lower miscarriage rate in the letrozole group (P=0.038). Serum FSH concentrations were comparable in both groups except on day 8, while oestradiol concentrations were all lower in the letrozole group from day 4 (all P<0.001). Follicular fluid concentrations of testosterone, androstenedione, FSH and anti-Mullerian hormone were higher in the letrozole group (P=0.009, P=0.001, P=0.046 and P=0.034, respectively). Compared with HMG alone, sequential use of letrozole and HMG in poor responders resulted in significantly lower total dosage and shorter duration of HMG, a comparable live-birth rate, a significantly lower miscarriage rate and a more favourable hormonal environment of follicular fluid. The management of poor ovarian responders or women with poor ovarian reserve in IVF is controversial. The use of letrozole has been studied; however, results are inconsistent. This randomized trial studied the sequential use of letrozole and gonadotrophin compared with gonadotrophin alone in poor responders undergoing IVF. The sequential use of letrozole and gonadotrophin led to a significantly lower dosage and shorter duration of gonadotrophin use, significantly fewer oocytes, comparable live-birth rate, a significantly lower miscarriage rate and a more favourable hormonal environment at a lower cost.en_HK
dc.languageengen_US
dc.publisherElsevier Ltd. The Journal's web site is located at http://www.elsevier.com/wps/find/journaldescription.cws_home/721149/description#descriptionen_HK
dc.relation.ispartofReproductive BioMedicine Onlineen_HK
dc.rightsNOTICE: this is the author’s version of a work that was accepted for publication in Reproductive BioMedicine Online. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in Reproductive BioMedicine Online, 2011, v. 23 n. 3, p. 380-388. DOI: 10.1016/j.rbmo.2011.05.012-
dc.rightsCreative Commons: Attribution 3.0 Hong Kong License-
dc.subject.meshAndrostenedione - metabolism-
dc.subject.meshAromatase Inhibitors - administration and dosage - therapeutic use-
dc.subject.meshMenotropins - administration and dosage - therapeutic use-
dc.subject.meshNitriles - administration and dosage - therapeutic use-
dc.subject.meshTriazoles - administration and dosage - therapeutic use-
dc.titleSequential use of letrozole and gonadotrophin in women with poor ovarian reserve: a randomized controlled trialen_HK
dc.typeArticleen_HK
dc.identifier.emailLee, VCY: v200lee@hku.hken_HK
dc.identifier.emailChan, CCW: chanccw@hkucc.hku.hken_HK
dc.identifier.emailNg, EHY: nghye@hku.hken_HK
dc.identifier.emailYeung, WSB: wsbyeung@hkucc.hku.hk-
dc.identifier.emailHo, PC: pcho@hku.hk-
dc.identifier.authorityNg, EHY=rp00426en_HK
dc.identifier.authorityYeung, WSB=rp00331en_HK
dc.identifier.authorityHo, PC=rp00325en_HK
dc.description.naturepostprint-
dc.identifier.doi10.1016/j.rbmo.2011.05.012en_HK
dc.identifier.pmid21782514-
dc.identifier.scopuseid_2-s2.0-80052406526en_HK
dc.identifier.hkuros201402en_US
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-80052406526&selection=ref&src=s&origin=recordpageen_HK
dc.identifier.volume23en_HK
dc.identifier.issue3en_HK
dc.identifier.spage380en_HK
dc.identifier.epage388en_HK
dc.identifier.isiWOS:000303044700018-
dc.publisher.placeUnited Kingdomen_HK
dc.identifier.scopusauthoridHo, PC=7402211440en_HK
dc.identifier.scopusauthoridYeung, WSB=7102370745en_HK
dc.identifier.scopusauthoridNg, EHY=35238184300en_HK
dc.identifier.scopusauthoridChan, CCW=26643394500en_HK
dc.identifier.scopusauthoridLee, VCY=35758969300en_HK

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