Volume 12, Issue 11 (12-2014)                   IJRM 2014, 12(11): 725-0 | Back to browse issues page

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Eftekhar M, Mohammadian F, Davar R, Pourmasumi S. Comparison of pregnancy outcome after letrozole versus clomiphene treatment for mild ovarian stimulation protocol in poor responders. IJRM. 2014; 12 (11) :725-0
URL: http://journals.ssu.ac.ir/ijrmnew/article-1-491-en.html
1- Research and Clinical Center for Infertility, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
2- Department of Obstetrics and Gynecology, Zanjan University of Medical Sciences, Zanjan, Iran
3- Research and Clinical Center for Infertility, Shahid Sadoughi University of Medical Sciences, Yazd, Iran , spourmasumi@yahoo.com
Abstract:   (817 Views)
Background: Poor ovarian response to controlled ovarian stimulation is one of the most important interest points in assisted reproduction. Mild ovarian stimulation seems to be preferable to high dose of FSH regimens in women with a history of poor ovarian response in previous protocol. Clomiphene citrate and letrozole alone or in combination with FSH have been used in mild ovarian stimulation protocol.
Objective: To compare the efficacy of letrozole and clomiphene citrate for mild ovarian stimulation on assisted reproductive technology outcomes in poor responders.
Materials and Methods: In a randomized control study, 184 women aged between 20 and 45 years with the history of poor response to ovarian stimulation who were candidate for ART were randomly subdivided into two groups: group I (n= 80), women who underwent the clomiphene/gonadotropin/antagonist protocol; and group II (n= 87), patients who underwent the letrozole/gonadotropin/antagonist protocol. Groups were compared regarding implantation, chemical and clinical pregnancy rates.
Results: There was a significant difference in the mean endometrial thickness between two groups (9.16±1.2 mm vs. 8.3±0.3 mm). The implantation rate was significantly higher in letrozole group compare to clomiphene group (7.2 vs. 6.6%, p=0.024 respectively). No significant differences were found in chemical and clinical pregnancy rate between two groups.
Conclusion: In mild ovarian stimulation protocol, letrozole and clomiphene have similar value for the poor responder. The optimal treatment strategy for these patients remains debated.
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Type of Study: Original Article |

References
1. Garcia-Velasco JA, Moreno L, Pacheco A, Guillén A, Duque L, Requena A, et al. The aromatase inhibitor letrozole increases the concentration of intra ovarian androgens and improves in vitro fertilization outcome in low responder patients: a pilot study. Fertil Steril 2005; 84: 82-87. [DOI:10.1016/j.fertnstert.2005.01.117]
2. Davar R, Oskouian H, Ahmadi S, Firouzabadi RD. GnRH antagonist/ letrozole versus microdose GnRH agonist flare protocol in poor responders undergoing in vitro fertilization. Taiwan J Obstet Gynecol 2010; 49: 297-301. [DOI:10.1016/S1028-4559(10)60064-2]
3. Yarali H, Esinler I, Polat M, Bozdag G, Tiras B. Antagonist/ letrozole protocol in poor ovarian responders for intracytoplasmic sperm injection: a comparative study with the microdose flare- up protocol. Fertil Steril 2009; 92: 231-235. [DOI:10.1016/j.fertnstert.2008.04.057]
4. Kyrou D, Kolibianakis EM, Venetis CA, Papanikolaou EG, Bontis J, Tarlatzis BC. How to improve the probability of pregnancy in poor responders undergoing in vitro fertilization: a systematic review and meta-analysis. Fertil Steril 2009; 91: 749-766. [DOI:10.1016/j.fertnstert.2007.12.077]
5. Revelli A, Casano S, Salvagno F, Delle Piane L. Milder is better? Advantages and disadvantages of "mild" ovarian stimulation for human in vitro fertilization. Reprod Biol Endocrinol 2011; 16: 25. [DOI:10.1186/1477-7827-9-25]
6. Check JH. Mild ovarian stimulation. J Assist Reprod Genet 2007; 24: 621-627. [DOI:10.1007/s10815-007-9179-9]
7. Karimzadeh MA, Ahmadi S, Oskouian H, Rahmani E.Comparison of mild stimulation and conventional stimulation in ART outcome. Arch Gynecol Obstet 2010; 281: 741-746. [DOI:10.1007/s00404-009-1252-4]
8. Verberg MF, Macklon NS, Nargund G, Frydman R, Devroey P, Broekmans FJ, et al. Mild ovarian stimulation for IVF. Hum Reprod Update 2009; 15: 13-29. [DOI:10.1093/humupd/dmn056]
9. Karimzadeh MA, Mashayekhy M, Mohammadian F, Moghaddam FM. Comparison of mild and microdose GnRH agonist flare protocols on IVF outcome in poor responders. Arch Gynecol Obstet 2011; 283: 1159-1164. [DOI:10.1007/s00404-010-1828-z]
10. Schoolcraft WB, Surrey ES, Minjarez DA, Stevens JM, Gardner DK. Management of poor responders: can outcomes be improved with a novel gonadotropin-releasing hormone antagonist/letrozole protocol? Fertil Steril 2008; 89: 151-156.
11. Mitwally MF, Casper RF. Aromatase inhibition reduces gonadotrophin dose required for controlled ovarian stimulation in women with unexplained infertility. Hum Reprod 2003; 18: 1588-1597. [DOI:10.1093/humrep/deg311]
12. Yanaihara A, Yorimitsu T, Motoyama H, Ohara M, Kawamura T. Mild stimulation with clomiphene citrate in combination with recombinant follicle-stimulating hormone and gonadotropin-releasing hormone antagonist and its influence on serum estradiol level and pregnancy rate. Reprod Med Biol 2008; 7: 85-89. [DOI:10.1111/j.1447-0578.2008.00204.x]
13. Baruah J, Roy KK, Rahman SM, Kumar S, Sharma JB, Karmakar D. Endometrial effects of letrozole and clomiphene citrate in women with polycystic ovary syndrome using spiral artery Doppler. Arch Gynecol Obstet 2009; 279: 311-314. [DOI:10.1007/s00404-008-0714-4]
14. Al-Fozan H, Al-Khadouri M, Tan SL, Tulandi T. A randomized trial of letrozole versus clomiphene citrate in women undergoing superovulation. Fertil Steril 2004; 82: 1561-1563. [DOI:10.1016/j.fertnstert.2004.04.070]
15. Jirge PR, Patil RS. Comparison of endocrine and ultrasound profiles during ovulation induction with clomiphene citrate and letrozole in ovulatory volunteer women. Fertil Steril 2010; 93: 174-183. [DOI:10.1016/j.fertnstert.2008.10.009]
16. Casper RF. Use of an aromatase inhibitor for induction of ovulation in patients with an inadequate response toclomiphene citrate. Fertil Steril 2001; 75: 305-309. [DOI:10.1016/S0015-0282(00)01705-2]
17. Badawy A, Elnashar A, Totongy M. Clomiphene citrate or aromatase inhibitors for superovulation in women with unexplained infertility undergoing intrauterine insemination: a prospective randomized trial. Fertil Steril 2009; 92: 1355-1359. [DOI:10.1016/j.fertnstert.2008.06.013]
18. Tulandi T, Martin J, Al-Fadhli R, Kabli N, Forman R, Hitkari J, et al. Congenital malformations among 911 newborns conceived after infertility treatment with letrozole or clomiphene citrate. Fertil Steril 2006; 85: 1761-1765. [DOI:10.1016/j.fertnstert.2006.03.014]

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