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Hum. Reprod. Advance Access published online on June 24, 2004
Human Reproduction, doi:10.1093/humrep/deh359
© 2004 by European Society of Human Reproduction and Embryology
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Received January 19, 2004
Accepted May 18, 2004

Article

A randomized single-blind controlled trial of letrozole as a low-cost IVF protocol in women with poor ovarian response: a preliminary report

S.K. Goswami 1, T. Das 1, R. Chattopadhyay 1, V. Sawhney 2, J. Kumar 2, K. Chowdhury 2, B.N. Chakravarty 1, S.N. Kabir 3*

1 Institute of Reproductive Medicine, Salt Lake, Kolkata 700091, West Bengal, India
2 School of Medical Science and Technology, Indian Institute of Technology, Kharagpur 721302, India
3 Reproductive Biology Research, Indian Institute of Chemical Biology, Jadavpur, Kolkata 700032, West Bengal, India

* To whom correspondence should be addressed. E-mail: snkabir{at}iicb.res.in, syednkabir@yahoo.com.


  Abstract

BACKGROUND: Use of letrozole, a selective inhibitor of aromatase, reduces the gonadotrophin dose required to induce follicular maturation. We evaluated whether incorporation of letrozole could be an effective low-cost IVF protocol for poor responders. METHODS: A randomized, controlled, single-blind trial was conducted in the Assisted Reproduction Unit, Institute of Reproductive Medicine, Kolkata, India. Thirty-eight women with a history of poor ovarian response to gonadotrophins were recruited. Thirteen women (Let-FSH group) received letrozole 2.5 mg daily from day 3-7, and recombinant FSH (rFSH) 75 IU/day on days 3 and 8; and 25 women (GnRH-ag-FSH group) underwent long GnRH agonist protocol and stimulated with rFSH (300-450 IU/day). Ovulation was triggered by 10 000 IU of HCG followed by IVF-embryo transfer. The main outcome measures were total dose of rFSH (IU/cycle), terminal estradiol (E2) (pg/ml), numbers of follicles, oocytes retrieved and transferable embryo, endometrial thickness (mm), and pregnancy rate. RESULTS: Compared with the GnRH-ag-FSH group (2865±228 IU), the Let-FSH group (150±0 IU) received a significantly (P<0.001) lower total dose of FSH. Except for terminal E2, which was significantly higher (P<0.001) in the GnRH-ag-FSH group (380±46 pg/ml) than the Let-FSH group (227±45 pg/ml), the treatment outcomes in all other respects, including pregnancy rate, were statistically comparable. CONCLUSIONS: Adjunctive use of letrozole may form an effective means of low-cost IVF protocol in poorly responding women.

Keywords: aromatase inhibitor; letrozole; low-cost IVF; poor ovarian responders.
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