Low Dose of Gonadotropin with Letrozole Versus High Dose of Gonadotropin in Patients with Poor Ovarian Response Undergoing Ivf: A Randomised, Single-Blind, Prospective Trial

Öz

Objective : The ideal controlled ovarian stimulation protocol for patients with poor ovarian response (POR) is not clear yet, and is the subject of many studies. Aromatase inhibitors have been introduced as a new treatment modality in controlled ovarian stimulation as they were found to elevate follicular sensitivity to gonadotropins(Gn). The aim of this study was to evaluate whether it is possible to reduce the required Gn dose by adding letrozole to the treatment without compromising success. Material and Methods: Patients who underwent in vitro fertilization treatment between 2014 and 2015 in our department and who were classified as poor responder patients according to Bologna criteria were recruited and randomized. In the first group, 33 patients were treated with 150 IU Gn in combination with letrozole 5 mg /day for the first five days of the stimulation. In the second group, 27 patients were treated with 300 IU Gn. Results: Amoung the groups there were no statistically significant difference in duration of ovulation stimulation, duration of antagonist use, number of retrieved oocytes, number of transferred embryos, implantation, cycle cancelation, chemical, clinical and ongoing pregnancy rates (all p>0.05). Gn use was significantly higher in 300 IU Gn alone group compared to 150 IU Gn in combination with letrozole group (1354 ± 468 IU versus 2555 ± 725 IU, p<0.05). Conclusion: The addition of letrozole yields comparable pregnancy outcomes with significantly low doses of Gn, so may be regarded as an effective adjuvant agent in POR patients.

Anahtar Kelimeler

• gonadotropin
• letrozole
• poor ovarian response

Poor Responder Hasta Grubunda Yüksek Doz Gonadotropine Karşı Letrozol ile Düşük Doz Gonadotropinin Karşılaştırılması: Randomize, Tek Kör, Prospektif Çalışma

Öz

Amaç: Kontrollü over stimülasyonuna zayıf cevap veren hastalar için ideal protokol henüz net değildir ve birçok çalışmanın konusudur. Aromataz inhibitörleri ile foliküllerde gonadotropin(Gn) duyarlılığının arttığı tespit edilmiştir. Bu çalışmanın amacı, başarıdan ödün vermeden tedaviye letrozol ekleyerek gerekli olan Gn dozunu azaltmanın mümkün olup olmadığını değerlendirmektir. Gereç ve Yöntem: Kliniğimizde 2014-2015 yılları arasında infertilite tedavisi gören ve Bologna kriterlerine göre zayıf cevap veren hasta olarak sınıflandırılan hastalar randomize edildi. Birinci hasta grubuna (n=33), stimülasyonun ilk beş günü için 5 mg/gün letrozol ile birlikte 150 IU/gün Gn uygulandı. İkinci gruba (n=27) ise sadece 300 IU/gün Gn uygulandı. Bulgular: Gruplar arasında ovulasyon stimülasyonu süresi, antagonist kullanım süresi, elde edilen oosit sayısı, transfer edilen embriyo sayısı, implantasyon, siklus iptali, kimyasal, klinik ve devam eden gebelik oranlarında istatistiksel olarak anlamlı bir fark yoktu (p> 0.05). Ancak Gn kullanımı, sadece 300 IU Gn grubunda, letrozol grubu ile birlikte 150 IU Gn'e kıyasla daha yüksekti (1354 ± 468 IU, 2555 ± 725 IU, p <0.05). Sonuç: Letrozol sayesinde önemli ölçüde düşük Gn dozları ile karşılaştırılabilir gebelik sonuçları elde edilmiştir, bu nedenle POR hastalarında etkili bir adjuvan ajan olarak kabul edilebilir.

Anahtar Kelimeler

• gonadotropin
• letrozol
• zayıf over yanıtı

Kaynakça

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