Aromatase inhibitors in “poor” ovarian responders undergoing in vitro fertilization

Cover Page

Abstract


Since the IVF treatment expands worldwide, it has become apparent that a proportion of women responds suboptimally to controlled ovarian stimulation with exogenous gonadotrophins. There is still no consensus on the ideal controlled ovarian stimulation protocol for patients with “poor” ovarian response. Many strategies have been studied. However, no compelling advantage for one treatment protocol over another has been identified. The addition of aromatase inhibitors in “poor” responders stimulation protocols is described in this article.


Alexandra I. Merkulova

Author for correspondence.
merkulova.alexandra@gmail.com
St Petersburg State University
Russian Federation, 7/9, Universitetskaya nab., St.Petersburg, 199034

PhD student of Medical department

  • Garcia J, Jones G, Acosta A, Wright G. Human menopausal gonadotropin/human chorionic gonadotropin follicular maturation for oocyte aspiration: Phase II, 1981. Fertility and Sterility. 1983;39(2):174-9. doi: 10.1016/s0015-0282(16)46815-9.
  • Tanbo T, Åbyholm T, Bjøro T, Dale P. Ovarian stimulation in previous failures from in-vitro fertilization: distinction of two groups of poor responders. Human Reproduction. 1990;5(7):811-5. doi: 10.1093/oxfordjournals.humrep.a137188.
  • Jeve Y, Bhandari H. Effective treatment protocol for poor ovarian response: A systematic review and meta-analysis. Journal of Human Reproductive Sciences. 2016;9(2):70. doi: 10.4103/0974-1208.183515.
  • Devine K, Mumford S, Wu M, et al. Diminished ovarian reserve in the United States assisted reproductive technology population: diagnostic trends among 181,536 cycles from the Society for Assisted Reproductive Technology Clinic Outcomes Reporting System. Fertility and Sterility. 2015;104(3):612-9.e3. doi: 10.1016/j.fertnstert.2015.05.017.
  • Ferraretti A, La Marca A, Fauser B, et al. ESHRE consensus on the definition of ‘poor response’ to ovarian stimulation for in vitro fertilization: the Bologna criteria. Human Reproduction. 2011;26(7):1616-24. doi: 10.1093/humrep/der092.
  • Cabry R, Merviel P, Hazout A, et al. Management of infertility in women over 40. Maturitas. 2014;78(1):17-21. doi: 10.1016/j.maturitas.2014.02.014.
  • Oudendijk J, Yarde F, Eijkemans M, et al. The poor responder in IVF: is the prognosis always poor? A systematic review. Human Reproduction Update. 2011;18(1):1-11. doi: 10.1093/humupd/dmr037.
  • Humaidan P, Alviggi C, Fischer R, Esteves S. The novel POSEIDON stratification of ‘Low prognosis patients in Assisted Reproductive Technology’ and its proposed marker of successful outcome. F1000Research. 2016;5:2911. doi: 10.12688/f1000research.10382.1.
  • De Vos M, Devroey P, Fauser B. Primary ovarian insufficiency. The Lancet. 2010;376(9744):911-921. doi: 10.1016/s0140-6736(10)60355-8.
  • Gleicher N, Yu Y, Himaya E, Barad D, et al. Early decline in functional ovarian reserve in young women with low (CGGn < 26) FMR1 gene alleles. Translational Research. 2015;166(5):502-7.e2. doi: 10.1016/j.trsl.2015.06.014.
  • Keay S, Liversedge N, Jenkins J. Could ovarian infection impair ovarian response to gonadotrophin stimulation? BJOG: An International Journal of Obstetrics and Gynaecology. 1998;105(3):252-4. doi: 10.1111/j.1471-0528.1998.tb10082.x.
  • Айламазян Э.К., Габелова К.А., Гзгзян А.М., Потин В.В. Аутоиммунный оофорит (патогенез, диагностика, перспективы лечения) //Акушерство и гинекология. – 2002. – № 2. – С. 7–9. [Ailamazyan EK, Gabelova KA, Gzgzyan AM, Potin VV. Autoimmunnyi ooforit (patogenez, diagnostika, perspektivy lecheniya). Akusherstvo i ginekologiya. 2002;(2):7-9. (In Russ.)]
  • Somigliana E, Berlanda N, Benaglia L, et al. Surgical excision of endometriomas and ovarian reserve: a systematic review on serum antimüllerian hormone level modifications. Fertility and Sterility. 2012;98(6):1531-8. doi: 10.1016/j.fertnstert.2012.08.009.
  • Takae S, Kawamura K, Sato Y, et al. Analysis of Late-Onset Ovarian Insufficiency after Ovarian Surgery: Retrospective Study with 75 Patients of Post-Surgical Ovarian Insufficiency. PLoS ONE. 2014;9(5):e98174. doi: 10.1371/journal.pone.0098174.
  • Johnson L, Sammel M, Schanne A, et al. Female cancer survivors exposed to alkylating-agent chemotherapy have unique reproductive hormone profiles. Fertility and Sterility. 2016;106(7):1793-9.e2. doi: 10.1016/j.fertnstert.2016.08.041.
  • Lunsford A, Whelan K, McCormick K, McLaren J. Antimüllerian hormone as a measure of reproductive function in female childhood cancer survivors. Fertility and Sterility. 2014;101(1):227-31. doi: 10.1016/j.fertnstert.2013.08.052.
  • Busnelli A, Papaleo E, Del Prato D, et al. A retrospective evaluation of prognosis and cost-effectiveness of IVF in poor responders according to the Bologna criteria. Human Reproduction. 2014;30(2):315-22. doi: 10.1093/humrep/deu319.
  • Papathanasiou A, Searle B, King N, Bhattacharya S. Trends in ‘poor responder’ research: lessons learned from RCTs in assisted conception. Human Reproduction Update. 2016;22(3):306-19. doi: 10.1093/humupd/dmw001.
  • Sunkara S, Coomarasamy A, Faris R, et al. Long gonadotropin-releasing hormone agonist versus short agonist versus antagonist regimens in poor responders undergoing in vitro fertilization: a randomized controlled trial. Fertility and Sterility. 2014;101(1):147-53. doi: 10.1016/j.fertnstert.2013.09.035.
  • Al-Inany H, Youssef M, Ayeleke R, et al. Gonadotrophin-releasing hormone antagonists for assisted reproductive technology. Cochrane Database of Systematic Reviews. 2016;4. doi: 10.1002/14651858.cd001750.pub4.
  • Papaleo E, Vanni V, Viganò P, et al. Recombinant LH administration in subsequent cycle after “unexpected” poor response to recombinant FSH monotherapy. Gynecological Endocrinology. 2014; 30(11):813-6 doi: 10. 3109/09513590.2014.932342.
  • Friedler S, et al. An upper limit of gonadotropin dose in patients undergoing ART should be advocated. Gynecological Endocrinology. 2016;32(12):965-9. doi: 10.1080/09513590.2016.1199018.
  • Land J, Yarmolinskaya M, Dumoulin J, Evers J. High-dose human menopausal gonadotropin stimulation in poor responders does not improve in vitro fertilization outcome. Fertility and Sterility. 1996;65(5):961-5. doi: 10.1016/s0015-0282(16)58269-7.
  • Kedem A, Tsur A, Haas J, Yerushalmi G, et al. Is the modified natural in vitro fertilization cycle justified in patients with “genuine” poor response to controlled ovarian hyperstimulation? Fertility and Sterility. 2014; 101(6):1624-8. doi: 10.1016/j.fertnstert.2014.02.036.
  • Abdel Mohsen I, Ezz El Din R. Minimal stimulation protocol using letrozole versus microdose flare up GnRH agonist protocol in women with poor ovarian response undergoing ICSI. Gynecological Endocrino logy. 2012;29(2): 105-8. doi: 10.3109/09513590.2012.730569.
  • Olgan S, Humaidan P. GnRH antagonist and letrozole co-treatment in diminished ovarian reserve patients: a proof-of-concept study. Reproductive Biology. 2017; 17(1):105-10. doi: 10.1016/j.repbio.2017.01.006.
  • Vlahos N, Papalouka M, Triantafyllidou O, et al. Dehydroepiandrosterone administration before IVF in poor responders: a prospective cohort study. Reproductive BioMedicine Online. 2015; 30(2):191-6. doi: 10.1016/j.rbmo.2014.10.005.
  • Zhang M, Niu W, Wang Y, et al. Dehydroepiandrosterone treatment in women with poor ovarian response undergoing IVF or ICSI: a systematic review and meta-analysis. Journal of Assisted Reproduction and Gene tics. 2016;33(8):981-91. doi: 10.1007/s10815-016-0713-5.
  • Nagels H, Rishworth J, Siristatidis C, Kroon B. Androgens (dehydroepiandrosterone or testosterone) for women undergoing assisted reproduction. Cochrane Database of Systematic Reviews. 2015. doi: 10.1002/14651858.cd009749.pub2.
  • Polyzos NP, Davis SR, Drakopoulos P, et al. Testosterone for Poor Ovarian Responders: Lessons From Ovarian Physiology. Reprod Sci. 2016; Aug 3. pii: 193371911 6660849. doi :10.1177/1933719116660849.
  • Bosdou J, Venetis C, Dafopoulos K, et al. Transdermal testosterone pretreatment in poor responders undergoing ICSI: a randomized clinical trial. Human Reproduction. 2016;31(5):977-85. doi: 10.1093/humrep/dew028.
  • Howles C, Loumaye E, Germond M, et al. Does growth hormone-releasing factor assist follicular development in poor responder patients undergoing ovarian stimulation for in-vitro fertilization? Human Reproduction. 1999;14(8):1939-43. doi: 10.1093/humrep/14.8.1939.
  • Ниаури Д.А., Гзгзян А.М., Коган И.Ю., и др. Эффективность применения соматотропного гормона в программах ЭКО/ЭКО+ИКСИ у женщин со «слабым» ответом яичников на стимуляцию гонадотропинами // Журнал акушерства и женских болезней. – 2015. – Т. 64. – № 6. – С. 43–50. [Niauri D, Gzgzyan A, Kogan I, et al. Effectiveness of growth hormone use in women with “poor” ovarian response to the stimulation of gonadotropins in IVF/IVF+ICSI programs. Journal of Obstetrics and Women’s Diseases. 2015;64(6):43-50. (In Russ.)]. doi: 10.17816/jowd64643-50.
  • Hart R, Rombauts L, Norman R. Growth hormone in IVF cycles. Current Opinion in Obstetrics and Gyneco logy. 2017;1. doi: 10.1097/gco.0000000000000360.
  • Pabuccu E, Caglar G, Pabuccu R. Estrogen or anti-estrogen for Bologna poor responders? Gynecological Endocrinology. 2015; 31(12):955-8. doi: 10.3109/09513590.2015.1081166.
  • Battaglia C, Salvatori M, Maxia N, et al. Adjuvant L-arginine treatment for in vitro fertilization in poor responder patients. Human Reproduction. 1999;14(7):1690-7. doi: 10.1093/humrep/14.7.1690.
  • Trakakis E, Vaggopoulos V, Sioulas V, et al. The contribution of sildenafil (Viagra) to ovarian stimulation with gonadotropins in a woman with poor ovarian response. Gynecological Endocrinology. 2014;30(7): 478-80. doi: 10.3109/09513590.2014.900034.
  • Caprio F, D’Eufemia M, Trotta C, et al. Myo-inositol therapy for poor-responders during IVF: a prospective controlled observational trial. Journal of Ovarian Research. 2015;8(1). doi: 10.1186/s13048-015-0167-x.
  • Davison S, Bell R, Donath S, et al. Androgen Levels in Adult Females: Changes with Age, Menopause, and Oophorectomy. The Journal of Clinical Endocrinology & Metabolism. 2005;90(7):3847-53. doi: 10.1210/jc.2005-0212.
  • Walters K. Role of androgens in normal and pathological ovarian function. Reproduction. 2014;149(4): R193-R218. doi: 10.1530/rep-14-0517.
  • Rice S, Ojha K, Whitehead S, Mason H. Stage-Specific Expression of Androgen Receptor, Follicle-Stimulating Hormone Receptor, and Anti-Müllerian Hormone Type II Receptor in Single, Isolated, Human Preantral Follicles: Relevance to Polycystic Ovaries. The Journal of Clinical Endocrinology Metabolism. 2007;92(3): 1034-40. doi: 10.1210/jc.2006-1697.
  • Suzuki T, Sasano H, Kimura N, et al. Physiology: Immunohistochemical distribution of progesterone, androgen and oestrogen receptors in the human ovary during the menstrual cycle: relationship to expression of steroidogenic enzymes. Human Reproduction. 1994;9(9):1589-95. doi: 10.1093/oxfordjournals.humrep.a138757.
  • Broekmans F, Soules M, Fauser B. Ovarian Aging: Mechanisms and Clinical Consequences. Endocrine Reviews. 2009;30(5):465-93. doi: 10.1210/er.2009-0006.
  • Amsterdam A, Hanoch T, Dantes A, et al. Mechanisms of gonadotropin desensitization. Molecular and Cellular Endocrinology. 2002;187(1-2):69-74. doi: 10.1016/s0303-7207(01)00701-8.
  • Guo J, Zhang Q, Li Y, et al. Predictive value of androgens and multivariate model for poor ovarian response. Reproductive BioMedicine Online. 2014;28(6):723-732. doi: 10.1016/j.rbmo.2014.02.009.
  • Bulun S, Imir G, Utsunomiya H, et al. Aromatase in endometriosis and uterine leiomyomata. The Journal of Steroid Biochemistry and Molecular Biology. 2005;95(1-5):57-62. doi: 10.1016/j.jsbmb.2005.04.012.
  • Bulun S, Yang S, Fang Z, et al. Role of aromatase in endometrial disease. The Journal of Steroid Biochemistry and Molecular Biology. 2001;79(1-5):19-25. doi: 10.1016/s0960-0760(01)00134-0.
  • Santen R, Brodie H, Simpson E, et al. History of Aromatase: Saga of an Important Biological Mediator and Therapeutic Target. Endocrine Reviews. 2009;30(4):343-375. doi: 10.1210/er.2008-0016.
  • Garcia-Velasco J. The use of aromatase inhibitors in vitro fertilization. Fertility and Sterility. 2012; 98(6):1356-8. doi: 10.1016/j.fertnstert.2012.09.042.
  • Holzer H, Casper R, Tulandi T. A new era in ovulation induction. Fertility and Sterility. 2006;85(2):277-284. doi: 10.1016/j.fertnstert.2005.05.078.
  • Bastu E, Buyru F, Ozsurmeli M, et al. A randomized, single-blind, prospective trial comparing three different gonadotropin doses with or without addition of letrozole during ovulation stimulation in patients with poor ovarian response. European Journal of Obstetrics Gynecology and Reproductive Biology. 2016;203:30-4. doi: 10.1016/j.ejogrb.2016.05.027.
  • Goswami S. A randomized single-blind controlled trial of letrozole as a low-cost IVF protocol in women with poor ovarian response: a preliminary report. Human Reproduction. 2004;19(9):2031-5. doi: 10.1093/humrep/deh359.
  • Ozmen B, Sönmezer M, Atabekoglu C, Olmuş H. Use of aromatase inhibitors in poor-responder patients receiving GnRH antagonist protocols. Reproductive BioMedicine Online. 2009;19(4):478-85. doi: 10.1016/j.rbmo.2009.05.007.
  • Yang R, Li H, Li R, et al. A comparison among different methods of letrozole combined with gonadotropin in an antagonist protocol and high-dose gonadotropin ovarian stimulation antagonist protocol in poor ovarian responders undergoing in vitro fertilization. Archives of Gynecology and Obstetrics. 2016;294(5):1091-7. doi: 10.1007/s00404-016-4164-0.
  • Hashim H. A. Aromatase Inhibitors for Endometriosis-Associated Infertility; Do We Have Sufficient Evidence? International Journal of Fertility Sterility. 2016;10(3):270. doi: 10.22074/ijfs.2016.50401.
  • Miller P, Parnell B, Bushnell G, et al. Endometrial receptivity defects during IVF cycles with and without letrozole. Human Reproduction. 2012;27(3):881-8. doi: 10.1093/humrep/der452.
  • Sayyah-Melli M, Mobasseri M, Gharabaghi P, et al. Comparing the effect of aromatase inhibitor (letrozole) + cabergoline (Dostinex) and letrozole alone on uterine myoma regression, a randomized clinical trial. European Journal of Obstetrics Gynecology and Reproductive Biology. 2017;210:257-64. doi: 10.1016/j.ejogrb.2016.11.001.
  • Tatsumi T, Jwa SC, Kuwahara A, et al. No increased risk of major congenital anomalies or adverse pregnancy or neonatal outcomes following letrozole use in assisted reproductive technology. Hum Reprod. 2017; 32(1):125-132. doi: 10.1093/humrep/dew280.
  • Sharma S, Ghosh S, Singh S, et al. Congenital Malformations among Babies Born Following Letrozole or Clomiphene for Infertility Treatment. PLoS ONE. 2014;9(10):e108219. doi: 10.1371/journal.pone.0108219.
  • Diamond M, Legro R, Coutifaris C, et al. Letrozole, Gonadotropin, or Clomiphene for Unexplained Infertility. New England Journal of Medicine. 2015;373(13):1230-40. doi: 10.1056/nejmoa1414827.

Views

Abstract - 62

PDF (Russian) - 33


Copyright (c) 2017 ECO-vector LLC

Creative Commons License
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.