Human Reproduction, Vol. 18, No. 8, 1588-1597,
August 2003
© 2003 European Society of Human Reproduction and Embryology
Aromatase inhibition reduces gonadotrophin dose required for controlled ovarian stimulation in women with unexplained infertility
1 Samuel Lunenfeld Research Institute and Mount Sinai Hospital, Reproductive Sciences Division, Department of Obstetrics & Gynecology, University of Toronto, Toronto, Canada and 2 Department of Gynecology and Obstetrics, State University of New York (SUNY) at Buffalo, Buffalo, New York, USA
3 Current address: Department of Gynecology and Obstetrics, State University of New York (SUNY) at Buffalo, 193 Kaymar Drive, Amherst, NY, 14228, USA
4 To whom correspondence should be addressed at: Samuel Lunenfeld Research Institute, Room 876, Mount Sinai Hospital, 600 University Avenue, Toronto, Ontario, M5G 1X5, Canada. e-mail: RFCasper{at}aol.com
BACKGROUND: Adding clomiphene citrate (CC) to FSH for controlled ovarian stimulation (COS) decreases FSH dose required for optimum stimulation. However, because of its anti-estrogenic effects, CC may be associated with lower pregnancy rates offsetting the FSH-dose reduction benefit. Previously, we reported the success of aromatase inhibition in inducing ovulation without antiestrogenic effects. METHODS: A prospective pilot study that included women with unexplained infertility undergoing COS and intrauterine insemination. Thirty-six women received the aromatase inhibitor letrozole + FSH, 18 women received CC + FSH and 56 women received FSH only. Each woman received one treatment regimen in one treatment cycle. All patients were given recombinant or highly purified FSH (50–150 IU/day) starting on day 3 to 7 until day of hCG. RESULTS: The FSH dose needed was significantly lower in letrozole + FSH and CC + FSH groups compared with FSH-only without a difference in number of follicles >1.8 cm. Pregnancy rate was 19.1% in the letrozole + FSH group, 10.5% in the CC + FSH group and 18.7% in the FSH-only group. Both pregnancy rate and endometrial thickness were significantly lower in CC + FSH group compared with the other two groups. Estradiol (E2) levels were significantly lower in the letrozole + FSH group compared with the other two groups. CONCLUSIONS: Similar to CC, aromatase inhibition with letrozole reduces FSH dose required for COS without the undesirable antiestrogenic effects sometimes seen with CC.
Key words: aromatase inhibitor/clomiphene citrate/controlled ovarian stimulation/letrozole/unexplained infertility
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