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Cited by 102Ovarian function and disordersReproductive Biology and FertilityReproductive Health and Technologies

Aromatase inhibition reduces the dose of gonadotropin required for controlled ovarian hyperstimulation

Mitwally, Mohamed F. M., Casper, Robert F.·2004·Journal of the Society for Gynecologic Investigation
DOI 10.1016/j.jsgi.2004.03.006
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Abstract

Objective To compare the use of the aromatase inhibitor, letrozole, in conjunction with follicle-stimulating hormone (FSH) injection, and FSH alone for controlled ovarian hyperstimulation (COH) in patients with polycystic ovarian syndrome (PCOS) or ovulatory infertility.Methods This nonrandomized study included two study groups: 26 patients with PCOS and 63 with ovulatory infertility (unexplained infertility [41 patients], male factor infertility [17 patients], and endometriosis [5 patients]), who received letrozole in addition to FSH; and two control groups: 46 PCOS patients and 308 with ovulatory infertility (unexplained infertility [250 patients], male factor infertility [42 patients], and endometriosis [16 patients], who received FSH only. All patients had intrauterine insemination (IUI). Main outcome measures included dose of FSH used per cycle, number of preovulatory follicles greater than 16 mm in diameter, cancellation rate, and pregnancy rate.Results The FSH dose required for ovarian stimulation was significantly lower when letrozole was used in both study groups compared to the control groups without a significant difference in number of follicles greater than 16 mm. IUI cancellation rate was significantly lower with letrozole treatment in PCOS patients. In women with PCOS, clinical pregnancy rate per completed IUI cycle was 26.5% in the letrozole plus FSH group versus 18.5% in the FSH-only group. In ovulatory infertility patients, the pregnancy rate was similar in both study and control groups (11%).Conclusion We believe that inhibition of estrogen synthesis by aromatase inhibition will release the estrogenic negative feedback, resulting in an increase in endogenous FSH secretion. Moreover, by inhibiting conversion of androgens into estrogens, accumulating androgens may increase follicular sensitivity to FSH. Such a protocol has the potential to lower FSH treatment cost and may improve response for low responders who require high FSH doses during ovarian stimulation.

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Crossref · 10.1016/j.jsgi.2004.03.006

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  • The addition of letrozole to FSH treatment leads to a decreased FSH requirement.

    “The addition of letrozole to FSH treatment leads to a decreased FSH requirement.”

    From A new era in ovulation induction (2006) · cites this paper as [63]

  • The pregnancy rate for treatment with letrozole and FSH was similar to that for FSH alone.

    “The pregnancy rate for treatment with letrozole and FSH was similar to that for FSH alone.”

    From A new era in ovulation induction (2006) · cites this paper as [63]

  • In another nonrandomized study, in women with PCOS, the pregnancy rate in the letrozole and FSH group was 26.5% per cycle and in the FSH-only group was 18.5% per cycle.

    “In women with PCOS (n ϭ 26), the pregnancy rate in the letrozole and FSH group was 26.5% per cycle and in the FSH-only group (n ϭ 46) was 18.5% per cycle.”

    From A new era in ovulation induction (2006) · cites this paper as [63]

  • In women without PCOS, there was no significant difference in pregnancy rates between the letrozole and FSH and FSH-alone groups.

    “In women without PCOS, there was no significant difference in pregnancy rates between the letrozole and FSH (n ϭ 63) and FSH-alone (n ϭ 308) groups.”

    From A new era in ovulation induction (2006) · cites this paper as [63]

  • The addition of letrozole to FSH treatment led to a lower FSH requirement without a significant difference in number of follicles >16 mm.

    “However, the addition of letrozole to FSH treatment led to a lower FSH requirement without a significant difference in number of follicles Ͼ16 mm.”

    From A new era in ovulation induction (2006) · cites this paper as [63]

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Authors
Mitwally, M. F. M., & Casper, R. F.
Affiliations
  • University of Toronto (CA)
  • Mount Sinai Hospital (CA)
Corresponding author
Casper, Robert F.
ORCID
Casper, Robert F.
Venue
Journal of the Society for Gynecologic Investigation
Publisher
Springer Science and Business Media LLC
Published
2004-09
Volume
11
Issue
6
Pages
406-415
ISSN
1071-5576 (ISSN-L)
DOI
10.1016/j.jsgi.2004.03.006
OpenAlex
W2079266189
Cited by
102
References
81
Citations by year
2026: 2 · 2025: 3 · 2024: 2 · 2023: 1 · 2022: 3 · 2021: 3 · 2020: 3 · 2019: 3 · 2017: 2 · 2016: 1 · 2015: 4 · 2014: 1 · 2013: 6 · 2012: 7
FWCI
11.11
Type
journal article
Language
en
Open access
closed
Licence
journals.sagepub.com/page/policies/text-and-data-mining-license (tdm)
Locations
  • Journal of the Society for Gynecologic Investigation (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Reproductive Medicine › Ovarian function and disorders
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Reproductive Biology and Fertility
  • Health Sciences › Medicine › Reproductive Medicine › Reproductive Health and Technologies
Keywords
letrozole, aromatase inhibition, controlled ovarian stimulation, follicle-stimulating hormone, polycystic ovary syndrome, ovulatory infertility, intrauterine insemination, estrogen negative feedback, low responders, pregnancy rate
MeSH terms
Letrozole, Adult, Female, Follicle Stimulating Hormone, Ovarian Follicle, Humans, Infertility, Female, Nitriles, Ovulation Induction, Polycystic Ovary Syndrome, Triazoles, Aromatase Inhibitors

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