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Hum. Reprod. Advance Access originally published online on May 15, 2008
Human Reproduction 2008 23(8):1820-1829; doi:10.1093/humrep/den131
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© The Author 2008. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Short-term androgen priming by use of aromatase inhibitor and hCG before controlled ovarian stimulation for IVF. A randomized controlled trial

K. Lossl1,3, C. Yding Andersen2, A. Loft1, N.L.C. Freiesleben1, S. Bangsbøll1 and A. Nyboe Andersen1

1 The Fertility Clinic, Section 4071, Copenhagen University Hospital, Rigshospitalet, DK-2100 Copenhagen, Denmark 2 Laboratory of Reproductive Biology, Section 5712, Copenhagen University Hospital, Rigshospitalet, DK-2100 Copenhagen, Denmark

3 Correspondence address. E-mail: kristine.loessl{at}rh.dk

BACKGROUND: Temporary exposure of follicles to increased levels of androgens may augment follicular responsiveness. The present study tested whether short-term androgen priming by aromatase inhibitor and human chorionic gonadotrophin (hCG) before controlled ovarian stimulation (COS) increases the number of top-quality embryos after IVF/ICSI.

METHODS: Patients were randomized to androgen priming (n = 53): anastrozole 1 mg cycle day (c.d.) 2, 3 and 4, hCG 1250 IU and cetrorelix 3 mg on c.d. 2, rFSH 150 IU from c.d. 5 following a flexible antagonist protocol; or control (n = 50): flexible antagonist protocol.

RESULTS: The mean (confidence interval) number of top-quality embryos was 1.08 (0.83,1.40) and 1.43 (1.12,1.81) in the priming and control group, respectively, being 32% (–7%, 89%) higher in the control compared to priming group (P = 0.120). Stimulation duration was longer in the priming group (P < 0.001). On the day of hCG administration, the proportion of c.d. 2 antral follicles reaching ≥14 mm was higher in the priming group (P = 0.014), as were serum estradiol (E2) (P < 0.001) and E2 per follicle ≥14 mm (P = 0.005). Pre-ovulatory follicular fluid levels of E2 (P = 0.007) and testosterone (P = 0.014) were higher in the priming group. The number of oocytes retrieved was similar. The fertilization rate was lower in the priming group (P = 0.007). Ongoing pregnancy rates in priming and control group were 30 and 36% (P = 0.531).

CONCLUSIONS: Administration of aromatase inhibitor and hCG before COS for IVF/ICSI failed to improve the number of top-quality embryos. ClinicalTrials.gov Identifier is NCT00286364 [ClinicalTrials.gov] .

Key words: androgens/aromatase inhibitor/follicular fluid/hCG/IVF

Submitted on November 7, 2007; resubmitted on March 14, 2008; accepted on March 28, 2008.


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K. Lossl, C. Y. Andersen, A. Loft, and A. N. Andersen
Reply: Androgen priming before ovarian stimulation for IVF
Hum. Reprod., September 5, 2008; (2008) den320v1.
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