A randomized single-blind controlled trial of letrozole as a low-cost IVF protocol in women with poor ovarian response: a preliminary report.
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.
Goswami
S K
SK
Institute of Reproductive Medicine, Salt Lake, Kolkata 700091, India.
Das
T
T
Chattopadhyay
R
R
Sawhney
V
V
Kumar
J
J
Chaudhury
K
K
Chakravarty
B N
BN
Kabir
S N
SN
D000328:Adult; D047072:Aromatase Inhibitors / Q000191:economics* / Q000627:therapeutic use*; D006063:Chorionic Gonadotropin / Q000627:therapeutic use; D003363:Cost Control; D004305:Dose-Response Relationship, Drug; D004351:Drug Resistance; D004624:Embryo Transfer; D004958:Estradiol / Q000097:blood; D005260:Female; D005307:Fertilization in Vitro / Q000191:economics*; D005640:Follicle Stimulating Hormone / Q000008:administration & dosage / Q000627:therapeutic use; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists; D006062:Gonadotropins / Q000627:therapeutic use*; D006801:Humans; D000077289:Letrozole; D009570:Nitriles / Q000191:economics* / Q000627:therapeutic use*; D010053:Ovary / Q000187:drug effects*; D011247:Pregnancy; D018873:Pregnancy Rate; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000627:therapeutic use; D016037:Single-Blind Method; D016896:Treatment Outcome; D014230:Triazoles / Q000191:economics* / Q000627:therapeutic use*
D047072:Aromatase Inhibitors; D006063:Chorionic Gonadotropin; D006062:Gonadotropins; D009570:Nitriles; D011994:Recombinant Proteins; D014230:Triazoles; D007987:Gonadotropin-Releasing Hormone; D004958:Estradiol; D000077289:Letrozole; D005640:Follicle Stimulating Hormone