A comparison of two months pretreatment with GnRH agonists with or without an aromatase inhibitor in women with ultrasound-diagnosed ovarian endometriomas undergoing IVF

Cantor A, Arielle Cantor, Tannus S, Samer Tannus, Weon‐Young Son, Son WY, Weon-Young Son, Seang Lin Tan, Michael H. Dahan
Reproductive BioMedicine Online · 2018 · vol. 38(4) , pp. 520–527 · doi:10.1016/j.rbmo.2018.12.028 · PMID:30935663 · W2905700644
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This study compared two months of GnRH agonist pretreatment with or without an aromatase inhibitor in women with ovarian endometriomas undergoing IVF.

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Abstract

RESEARCH QUESTION: Does the addition of an aromatase inhibitor improve IVF outcomes in women with endometriomas when pretreating them with gonadotrophin-releasing hormone agonists? DESIGN: Retrospective two-centre cohort study involving 126 women aged 21-39 years who failed a previous IVF cycle and all subsequent embryo transfers and had sonographic evidence of endometriomas. Women were non-randomly assigned to either 3.75 mg intramuscular depo-leuprolide treatment alone or in combination with 5 mg of oral letrozole daily for 60 days prior to undergoing a fresh IVF cycle. Main outcome measures included clinical pregnancy rate and ongoing pregnancy rate after 24 weeks' gestation. RESULTS: Prior to treatment, antral follicle count (AFC), basal serum FSH and endometrioma diameter did not differ between groups. After treatment, AFC differed between letrozole and non-letrozole-treated groups (10.3 ± 2.0 versus 6.4 ± 2.5; P = 0.0001), as did mean endometrioma maximum diameter (1.8 ± 0.4 cm versus 3.2 ± 0.8 cm; P = 0.0001). At IVF, the gonadotrophin dose used was significantly lower in letrozole-treated subjects (2079 ± 1119 versus 3716 ± 1314; P = 0.0001), the number of mature oocytes collected was greater (9.1 ± 2.4 versus 4.0 ± 1.7; P = 0.0001), as were the number of two-pronuclear embryos and number of blastocysts. The clinical pregnancy rate was significantly higher in the letrozole-treated group (50% versus 22%, P = 0.003), as was the live birth rate (40% versus 17%, P = 0.008). CONCLUSIONS: The combination of depo-leuprolide acetate monthly for 60 days combined with daily letrozole has better clinical outcomes at IVF in women with endometriomas than depo-leuprolide acetate treatment alone.

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Condition tags

endometriosis

MeSH descriptors

Aromatase Inhibitors Endometriosis Fertilization in Vitro Fertilization in Vitro Gonadotropin-Releasing Hormone Infertility, Female Ovarian Neoplasms Adult Adult Aromatase Inhibitors Aromatase Inhibitors Endometriosis Endometriosis Endometriosis Endometriosis Female Female Gonadotropin-Releasing Hormone Gonadotropin-Releasing Hormone Humans

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