P-586 Adding letrozole to gonadotropins during ovarian stimulation for IVF results in a similar cumulative live birth rate at lower costs following a failed IVF cycle
Notice bibliographique
Résumé
Abstract Study question Following a failed IVF cycle, does adding letrozole for the first 5 days of a repeated cycle have any advantage versus repeating the same protocol? Summary answer Following a failed IVF cycle, letrozole supplementation during ovarian stimulation for IVF results in a similar cumulative live birth rate (CLBR) with 22% less gonadotropins. What is known already Letrozole results in an increase of intraovarian androgen concentration, which augments follicular stimulating hormone (FSH) receptor expression on granulosa cells and follicular responsiveness to exogenous gonadotropins. Letrozole co-treatment with gonadotropins during controlled ovarian stimulation (COH) for IVF has been investigated mainly in poor and normo-responders with conflicting clinical outcomes. This is the first and largest study that investigates the effects of adding letrozole for the first five days of COH for IVF, in GnRH antagonist cycles, to a category of patients who had a prior failed stimulated IVF cycle using the same protocol. Study design, size, duration This is retrospective monocentric study of 426 patients, with a prior failed stimulated IVF cycle using an antagonist protocol, who underwent a second cycle between 2012 and 2017. In those patients, we studied the clinical outcomes of doing a repeated cycle, using the same protocol with the addition of 5mg of letrozole daily in the first 5 days of the cycle (Group A, N = 213) versus doing a repeated similar cycle without letrozole (Group B, N = 213). Participants/materials, setting, methods Groups A and B were matched for age, body mass index, anti-mullerian hormone and infertility diagnosis. Statistical analyses were carried out using student t test, Anova and linear regression models. The primary outcome was the CLBR. Secondary outcomes included the number of mature follicles, the number of mature oocytes (MII), the number of usable embryos, clinical pregnancy rates (CPR), live birth rates (LBR) and the total dose of gonadotropins administered. Main results and the role of chance This is the first study that investigates the effects of co-treatment with letrozole during COH for IVF in the category of patients who had a prior failed IVF cycle. Our results show that patients who received letrozole during COH with gonadotropins, versus gonadotropins alone, had a significantly lower number of MII oocytes (7±4.6 vs 8,2±5.0; P < 0.01). However, despite that, they had a similar number of usable embryos (1.8±1.6 vs 1.9±1.7; P = 0.31), CPR (23.5% vs 28.7%; p = 0.22), LBR per embryo transfer (16.9% vs 22.1%; p = 0.17) and CLBR (27.8% vs 25.3%; p = 0.55). A 22% lower dose of gonadotropins (3468±1389IU vs 4442±1657IU; p < 0.001) was needed to achieve similar pregnancy outcomes in the letrozole group versus the control group, resulting in lower treatment costs. Limitations, reasons for caution The retrospective nature of this study is its main limitation. Wider implications of the findings This study confirms that in women with a prior failed IVF cycle, co-treatment with letrozole results a similar cumulative live birth rate at a significant lower cost. Trial registration number NCT05677828
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».