Effect of GnRH agonist and letrozole treatment in women with recurrent implantation failure

Steiner N, Naama Steiner, Guy Shrem, Tannus S, Samer Tannus, Dahan SY, S Dahan, S Yehuda Dahan, Balayla J, Jacques Balayla, Alexander Volodarsky‐Perel, Alexander Volodarsky-Perel, Seang-Lin Tan, Seang Lin Tan, Dahan MH, Michael H Dahan
Fertility and sterility · 2019 · vol. 112(1) , pp. 98–104 · doi:10.1016/j.fertnstert.2019.03.021 · PMID:31133384 · W2945613756
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This study investigated the effects of GnRH agonist and letrozole treatment on women experiencing recurrent implantation failure.

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Abstract

ObjectiveTo compare the influence of dual suppression with the use of GnRH agonist plus aromatase inhibitor compared with suppression with the use of GnRH agonist alone or no suppression at all in patients with idiopathic recurrent implantation failure (RIF).DesignRetrospective cohort study.SettingUniversity-affiliated reproductive center.Patient(s)A total of 523 infertile women who failed two blastocyst transfers underwent a third frozen blastocyst transfer. Women with known endometriosis were excluded.Intervention(s)A total of 204 subjects were not pretreated, 143 received 2 months of GnRH agonist (3.75 mg intramuscular leuprolide acetate monthly) only, and 176 received GnRH agonist and aromatase inhibitor (5 mg oral letrozole daily for 60 days). Demographic and stimulation information was collected and cycle outcomes reported.Main outcome measure(s)Clinical pregnancy rates.Result(s)Age, antral follicle count, basal FSH levels, duration of infertility, previous pregnancies, and full-term deliveries were similar (P>.05). Clinical pregnancy rates were higher among women who received GnRH agonist plus letrozole compared with women who received GnRH agonist only or women without pretreatment (63%, 42%, and 40%, respectively; P<.0001). Live birth rates were higher among women who received GnRH agonist plus letrozole compared with the other groups (56%, 36%, and 34%; P<.0001). No differences in pregnancy outcomes were noted between patients who did not receive pretreatment and those in the GnRH agonist only group.Conclusion(s)In patients with RIF, treatment with a GnRH agonist plus letrozole may improve live birth rates in subsequent cycles. We hypothesize that this improvement is due to alterations in the endometrium receptivity or treatment of undiagnosed endometriosis.

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MeSH descriptors

Aromatase Inhibitors Embryo Implantation Embryo Transfer Embryo Transfer Fertility Agents, Female Fertilization in Vitro Fertilization in Vitro Gonadotropin-Releasing Hormone Infertility, Female Letrozole Leuprolide Adult Aromatase Inhibitors Aromatase Inhibitors Drug Therapy, Combination Embryo Implantation Female Fertility Fertility Fertility Agents, Female

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