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Letrozole versus hMG in intrauterine insemination cycles H. Jamal; H. Serdaroglu; A. Baysoy; E. Karatekeli; E. Attar; H. Ozornek Istanbul, Turkey Istanbul,

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Presentation on theme: "Letrozole versus hMG in intrauterine insemination cycles H. Jamal; H. Serdaroglu; A. Baysoy; E. Karatekeli; E. Attar; H. Ozornek Istanbul, Turkey Istanbul,"— Presentation transcript:

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2 Letrozole versus hMG in intrauterine insemination cycles H. Jamal; H. Serdaroglu; A. Baysoy; E. Karatekeli; E. Attar; H. Ozornek Istanbul, Turkey Istanbul, Turkey

3 Aromatase Inhibitors iii-Non-Steroid triazole group: Anastrazole, letrozole i-Steroid group: Exemestane ii-Non-Steroid imidazole group: Fadrozole.

4 letrozole letrozole reversible

5 Enhances ovarian response to gonadotropin stimulation Increases endogenous production of FSH Increasing intraovarian androgen levels Suppressing estrogen

6 Advantages of third-generation aromatase inhibitors Extremely potent inhibition of aromatase Very specific inhibition of aromatase without significant inhibition of other steroidogenesis enzymes Oral administration 100% bioavailability after oral administration Rapid clearance from the body (short half-life, ~ 45 hours) No accumulation of the medications or their metabolites No significant active metabolites Few mild adverse effects with high tolerability when given chronically Few contraindications or drug interactions Relatively inexpensive

7 Indications Ovulation induction Breast cancer Endometrial cancer Endometriosis uterine fibroids a) Unexplained infertility b) PCO c) Poor responders

8 Clinical pregnancy rate Human reproduction Mitwally et al Letrozole- FSH CC-FSH FSH-only IUI 19.1% 18.7% 10.5%

9 Clinical pregnancy rate Fertility and Sterility Healey et al FSHFSH+Letrozole IUI 20.9% 21.6%

10 A prospective randomized study comparing the results of intrauterine insemination (IUI) in women undergoing ovulation induction with either letrozole or Human Menopausal Gonadotropin (hMG). Objective

11 Letrozole grouphMG group IUI

12 80 couples LETROZOLE GROUP(40 CASES) hMG GROUP(40 CASES) regular menstrual cycles primary infertility female age <36 years All patients diagnosed as having unexplained infertility (lack of conception after at least 2 year of regular unprotected intercourse)

13 Transvaginal ultrasound Hormone profiles Semen analysis Hysterosalpingogram and/or Laparoscopy normal

14 length of follicular phase endometrial thickness cost premature LH surge 14 mm follicles clinical pregnancy rate OHSS and multiple pregnancy Letrozole & hMG

15 LH-surge was defined as an increase in LH level 100% over mean of preceding two days. LH surge?

16 Letrozole vs hMG Day 3 Day 7 Day 3 Day 7 Letrozole 2x1 hMG hMG 1x75ıu (<30 years) hMG 1x150ıu( 30years) HCG

17 No luteal support was given. IUI was performed by the same physician for all patients.

18 RESULTS Age (yrs) Duration of infertility (yrs) baseline FSH (IU/l) baseline LH (IU/l) baselin E 2 (pg/ml) Letrozole (n=40) 27.22±5.55.3± ± ± ±12.0 hMG 28.1±4.35.9± ± ± ±13.4 P: NS

19 Letrozole [40] 31.43± ± ± ± 11.3 Semen parameters before preparation for insemination RESULTS Age of male partner (yrs) Concentration ( x 10 6 /ml) Motility (%) Normal sperm forms (%) P value NSNSNSNS hMG [40] 30.10± ± ± ± 9.2

20 Letrozole12.77± ± ± ± ± %193.19±802 hMG11.90± ± ± %875.15±3682 Follicular p hase (days ) Follicle number Endometrial thickness(mm) Trilaminar pattern HCG day E2 Premature luteinization RESULTS P value NS <0.001 NSNS<0.001NS

21 Letrozole17.5%1(triplet)0 hMG 15 % 1(twin)1(moderate) Pregnancy rate Multiple pregnancy OHSS RESULTS P value NSNSNS

22 The mean dose of hMG (mean number of ampoules/cycle) was 15.5 ampoules/cycle. While the dose of letrozole were stable (10 tablets/cycle). Letrozole had a cost of 43 $ per cycle while hMG was more costly with 225 $ per cycle.

23 Conclusion Although low estradiol levels and less number of mature follicles were obtained at the time of the hCG in the letrozole group, pregnancy rates were similar in both groups.

24 Conclusion Another outcome we noticed that the stimulation time lasted longer in the letrozole group. As other authors cited before that this longer time of stimulation may have beneficial effects on oocyte maturation and oocyte quality and this is maybe a reason that more pregnancies occured in the letrozole group.

25 Conclusion Despite significantly lower E2 levels in the letrozole-treated women, endometrial development was unaffected, endometrial thickness and pattern were similar in both groups.

26 Conclusion Serious complications (OHSS, multiple pregnancy) were rare in the two groups. Low estradiol levels and less number of mature follicles at the time of the hCG in the letrozole group may be a reason to minimize and thereby avoid the complications of ovarian hyperstimulation syndrome (OHSS) and multiple pregnancy. But to compare such an outcome, a large study including a very large number of patients must be required.

27 letrozole efficient cost effective simple and convenient

28 Thanks!


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