使用letrozole誘導排卵COH，子宮內膜略薄於純粹排卵針COH

Hum Reprod. 2017 May 1;32(5):1009-1018. doi: 10.1093/humrep/dex035.

Endometrial thickness in women undergoing IUI with ovarian stimulation. How thick is too thin? A systematic review and meta-analysis.

Weiss NS1,2, van Vliet MN1, Limpens J3, Hompes PGA2, Lambalk CB2, Mochtar MH1, van der Veen F1, Mol BWJ4, van Wely M1.

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Abstract

STUDY QUESTION:

Is pre-ovulatory endometrial thickness (EMT) in women with unexplained subfertility undergoing IUI with ovarian stimulation (OS) associated with pregnancy chances?

SUMMARY ANSWER:

We found no evidence for an association between EMT and pregnancy chances.

WHAT IS KNOWN ALREADY:

It has been suggested that OS with clomiphene citrate (CC) results in a lower EMT than with gonadotrophins or aromatase inhibitors, but the clinical consequences in terms of pregnancy are unclear.

STUDY DESIGN, SIZE, DURATION:

We performed a systematic review and meta-analysis of studies comparing CC, gonadotrophins or aromatase inhibitors in an IUI program reporting on EMT and pregnancy rates in women with unexplained subfertility.

PARTICIPANTS/MATERIALS, SETTING, METHODS:

We searched MEDLINE, EMBASE and the non-MEDLINE subset of PubMed from inception to 28th June 2016 and cross-checked references of relevant articles. Outcome measures were clinical pregnancy rate and mean pre-ovulatory EMT. We calculated mean differences (MD) with 95% CIs with a fixed effect model, and in case of heterogeneity with an I2 > 50% a random effect model. We performed a meta-regression analysis to determine if stimulating drugs interacted with the estimated effect of EMT.

MAIN RESULTS AND THE ROLE OF CHANCE:

Our search retrieved 1563 articles of which 23 were included, totaling 3846 women. There were 17 RCTs and 6 cohort studies. The average study quality was low and there was considerable to substantial statistical heterogeneity. Seven studies provided data on EMT in relation to pregnancy. There was no evidence of a difference in EMT between women who conceived and women that did not conceive (1525 women, MDrandom: 0.51 mm, 95% CI: -0.05 to 1.07). Women treated with CC had a significantly thinner EMT than women treated with gonadotrophins (two studies, MD: -0.33, 95% CI: -0.64 to -0.01). There was no evidence of a difference in EMT when comparing CC with letrozole (five studies, MDrandom: -0.84, 95% CI: -1.97 to 0.28). The combination of CC plus gonadotrophins resulted in a slightly thinner endometrium than letrozole (nine studies, MDrandom: -0.79, 95% CI: -1.37 to -0.20). Letrozole resulted in a thinner EMT than gonadotrophins (two studies, MDrandom: -1.31, 95% CI: -2.08 to -0.53).

Letrozole 可提高男性賀爾蒙&FSH濃度進而提高精蟲品質

JBRA Assist Reprod. 2015 Nov 1;19(4):230-4. doi: 10.5935/1518-0557.20150045.

Letrozole Therapy for Obstructive Azoospermic Men before in vitro Fertilization (IVF) treatment with Percutaneous Epididymal Sperm Aspiration.

Bibancos M1, Cavagnoli M1, Bonetti TC2, Semaco E1, Motta EL1,2, Serafini PC1,2.

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Abstract

OBJECTIVE:

The aim of this study was to report our preliminary experience regarding the use of letrozole in men with obstructive azoospermia (OA) undergoing percutaneous epididymal sperm aspiration (PESA) for in vitro fertilization treatment using intracytoplasmic sperm injection (ICSI), who had a very low sperm recovery upon PESA and unsuccessful ICSI. Our hypothesis was that letrozole therapy could improve testicular function by increasing serum gonadotropins and T levels, stimulate testicle germ cells and, most importantly, that it enhanced the motile sperm count at a second attempt.

METHODS:

We report on our preliminary experience with letrozole therapy in 11 men with OA, who failed to achieve pregnancy in the first PESA-ICSI and did not have spermatozoa cryopreserved for a second attempt. The patients received 3 months of letrozole at 2.5mg/day and underwent PESA-ICSI after 6.1±3.8 months. The patients were 48.6 ± 9.6 years old, and underwent at least two PESA procedures. We evaluated the total motile sperm count per PESA samples, as the increases in serum FSH, LH, and T levels after treatment.

RESULTS:

All parameters increased significantly at 3 months following letrozole therapy for most patients. The total motile sperm count increased from 100 to 500% compared to the first PESA.

CONCLUSION:

Letrozole can be considered a reliable treatment to improve sperm recovery for men with OA undergoing PESA-ICSI cycles by increasing serum gonadotropins and testosterone (T) levels, and-most importantly-the motile sperm count.

Letrozole用於IVF誘導排卵之黃體期
P4並不會明顯下降
E2會下降

Hum Reprod. 2015 Sep;30(9):2184-9. doi: 10.1093/humrep/dev155. Epub 2015 Jun 24.

Progesterone levels in letrozole associated controlled ovarian stimulation for fertility preservation in breast cancer patients.

Goldrat O1, Gervy C2, Englert Y3, Delbaere A3, Demeestere I3.

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Abstract

STUDY QUESTION:

Are progesterone levels after letrozole-associated controlled ovarian stimulation (COS) for fertility preservation in breast cancer patients, lower than after standard in vitro fertilization (IVF) cycles?

SUMMARY ANSWER:

During the luteal phase of letrozole-associated COS cycles (triggered with human chorionic gonadotrophin (hCG)) progesterone levels are similarly elevated to those obtained after standard COS without letrozole.

WHAT IS KNOWN ALREADY:

Current fertility preservation strategies for breast cancer patients include association of COS with the aromatase inhibitor letrozole to harvest several mature oocytes while maintaining low estradiol levels. Data on progesterone levels are however lacking despite growing evidence of the role of progesterone in breast tumorigenesis.

STUDY DESIGN, SIZE, DURATION:

This is a prospective observational study comparing estradiol and progesterone levels of 21 breast cancer patients undergoing letrozole-associated COS with 21 infertile patients undergoing standard COS for IVF and/or intra cytoplasmic sperm injection (ICSI).

PARTICIPANTS/MATERIALS, SETTING, METHODS:

All patients underwent COS with a GnRH antagonist protocol. In the fertility preservation group, ovulation induction was started in the follicular or luteal phase depending on the chemotherapy schedule and in 10 cases a GnRH antagonist was administered during luteal phase to induce luteolysis. Final oocyte maturation was induced by hCG in all patients. Estradiol and progesterone levels were measured on the day of hCG, at oocyte retrieval, and on days 3 and 8 after oocyte retrieval. Hormone levels in fertility preservation patients were compared with those observed in infertility patients.

MAIN RESULTS AND THE ROLE OF CHANCE:

While estradiol levels were significantly lower in the fertility preservation group compared with the control group (P < 0.001), progesterone levels were similar at all times, including patients receiving a GnRH antagonist during the luteal phase.