Ebrahimi Mahbod, Akbari Asbagh Firoozeh, Davari Tanha Fatemeh, Pakniat Hamideh, Feizabad Elham, Rasouli Yasin
Department of Obstetrics and Gynecology, Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Department of Obstetrics and Gynecology, Faculty of Medicine, Qazvin University of Medical Sciences, Qazvin, Iran.
Int J Reprod Biomed. 2022 Jul 6;20(6):483-490. doi: 10.18502/ijrm.v20i6.11444. eCollection 2022 Jun.
The common causes of infertility in women with endometriosis are folliculogenesis alternation, steroidogenesis and fertilization impairment, oocyte and embryo quality reduction, and implantation defect.
To compare in vitro fertilization (IVF) cycle success rates of women with endometriosis who were treated with letrozole + gonadotropin (LA) vs. placebo + gonadotropin (PA).
This double-blind, randomized clinical trial study was conducted with 94 infertile women with endometriosis (47 in the LA group and 47 in the PA group) who were candidates for IVF, from April-June 2021. For all participants, the long agonist protocol was applied. In both groups, gonadotropin-releasing hormone agonist was prescribed in the mid-luteal stage and from the third day of the cycle, and gonadotropin was started and its doses were regulated based on the patient's age, serum anti-Mullerian hormone and follicle-stimulating hormone. From the third day of the menstrual cycle, 5 mg of letrozole daily for 5 days was prescribed for the LA group, while the placebo was prescribed for the PA group on the identical days and duration. After embryo transfer, biochemical and clinical pregnancy were measured in the 2 groups.
The gonadotropin dosage (p 0.01) and estradiol level (p = 0.02) on the human chorionic gonadotropin administration day were significantly lower in the LA group compared with in the PA group. Fetus transfer was done for 32 women. No significant differences were detected between the study groups regarding biochemical or clinical pregnancy (p = 0.72 for both).
Letrozole as a co-treatment drug in the IVF cycle of women with endometriosis can significantly reduce the gonadotropin dosage and estradiol level with the same pregnancy rates.
子宫内膜异位症女性不孕的常见原因包括卵泡发生改变、类固醇生成及受精障碍、卵母细胞和胚胎质量下降以及着床缺陷。
比较来曲唑+促性腺激素（LA）与安慰剂+促性腺激素（PA）治疗的子宫内膜异位症女性体外受精（IVF）周期成功率。
本双盲、随机临床试验于2021年4月至6月对94例子宫内膜异位症不孕女性（LA组47例，PA组47例）进行，这些女性均为IVF候选者。所有参与者均采用长效激动剂方案。两组在黄体中期及周期第3天开始使用促性腺激素释放激素激动剂，开始使用促性腺激素并根据患者年龄、血清抗苗勒管激素和卵泡刺激素调整剂量。月经周期第3天起，LA组每天服用5mg来曲唑，共5天，而PA组在相同日期和时间段服用安慰剂。胚胎移植后，测量两组的生化妊娠和临床妊娠情况。
与PA组相比，LA组在人绒毛膜促性腺激素给药日的促性腺激素剂量（p = 0.01）和雌二醇水平（p = 0.02）显著更低。32名女性进行了胚胎移植。研究组之间在生化妊娠或临床妊娠方面未检测到显著差异（两者p = 0.72）。
来曲唑作为子宫内膜异位症女性IVF周期的联合治疗药物，可在相同妊娠率的情况下显著降低促性腺激素剂量和雌二醇水平。
