Aromatase inhibition reduces gonadotrophin dose required for controlled ovarian stimulation in women with unexplained infertility
Aromatase inhibition reduces gonadotrophin dose required for controlled ovarian stimulation in women with unexplained infertility
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DOI：
10.1093/humrep/deg311
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发表时间：
2003-08-01
影响因子：
6.1
通讯作者：
Casper, RF
中科院分区：
文献类型：
--
作者：
Mitwally, MFM;Casper, RF
背景：在FSH中加入克罗米芬（CC）进行控制性卵巢刺激（COS）可降低最佳刺激所需的FSH剂量。然而，由于其抗雌激素作用，CC可能与较低的妊娠率相关，抵消了FSH剂量减少的益处。以前，我们报道了芳香化酶抑制剂在诱导排卵方面的成功，而没有抗雌激素作用。方法：一项前瞻性的试点研究，包括不明原因的不孕妇女接受COS和宫腔内人工授精。36名妇女接受芳香化酶抑制剂来曲唑+FSH，18名妇女接受CC + FSH，56名妇女仅接受FSH。每名妇女在一个治疗周期内接受一种治疗方案。所有患者从第3天至第7天开始给予重组或高纯度FSH（50 - 150 IU/天），直至hCG日。研究结果：来曲唑+FSH组和CC + FSH组所需FSH剂量显著低于仅FSH组，但> 1.8 cm卵泡数无差异。妊娠率来曲唑+FSH组为19.1%，CC + FSH组为10.5%，单用FSH组为18.7%。CC + FSH组的妊娠率和子宫内膜厚度均显著低于其他两组。来曲唑+FSH组E2水平显著低于其他两组。结论：与CC相似，来曲唑抑制芳香酶可减少COS所需的FSH剂量，而不会出现CC有时会出现的不良抗雌激素作用。
BACKGROUND: Adding clomiphene citrate (CC) to FSH for controlled ovarian stimulation (COS) decreases FSH dose required for optimum stimulation. However, because of its anti-estrogenic effects, CC may be associated with lower pregnancy rates offsetting the FSH-dose reduction benefit. Previously, we reported the success of aromatase inhibition in inducing ovulation without antiestrogenic effects. METHODS: A prospective pilot study that included women with unexplained infertility undergoing COS and intrauterine insemination. Thirty-six women received the aromatase inhibitor letrozole + FSH, 18 women received CC + FSH and 56 women received FSH only. Each woman received one treatment regimen in one treatment cycle. All patients were given recombinant or highly purified FSH (50-150 IU/day) starting on day 3 to 7 until day of hCG. RESULTS: The FSH dose needed was significantly lower in letrozole + FSH and CC + FSH groups compared with FSH-only without a difference in number of follicles >1.8 cm. Pregnancy rate was 19.1% in the letrozole + FSH group, 10.5% in the CC + FSH group and 18.7% in the FSH-only group. Both pregnancy rate and endometrial thickness were significantly lower in CC + FSH group compared with the other two groups. Estradiol (E-2) levels were significantly lower in the letrozole + FSH group compared with the other two groups. CONCLUSIONS: Similar to CC, aromatase inhibition with letrozole reduces FSH dose required for COS without the undesirable antiestrogenic effects sometimes seen with CC.