1) Letrozole is an aromatase inhibitor that has been shown to be an effective ovulation induction drug for infertility treatment, with benefits over clomiphene citrate such as higher ovulation and pregnancy rates and lower risk of multiple pregnancies and ovarian hyperstimulation syndrome.
2) A landmark randomized controlled trial found letrozole resulted in higher live birth rates compared to clomiphene citrate for infertility treatment in women with polycystic ovary syndrome.
3) Guidelines recommend letrozole as a first-line treatment option for ovulation induction in infertility, similar to clomiphene citrate. Letrozole is particularly beneficial in cases of clomiphene citrate resistance
This document discusses the use of letrozole for ovulation induction. It begins by explaining how letrozole works at a molecular level to stimulate follicular growth, noting key differences from clomiphene citrate such as not blocking estrogen receptors and maintaining feedback inhibition. Clinical studies are then summarized finding letrozole to have higher ovulation and live birth rates than clomiphene citrate, especially in women with PCOS or who are clomiphene citrate resistant. The document concludes by stating letrozole has been used successfully for ovulation induction in PCOS, intrauterine insemination, and ovarian stimulation for IVF/ICSI.
GnRH Antagonists in Controlled Ovarian StimulationSandro Esteves
This document provides an overview of a lecture on LH suppression in controlled ovarian hyperstimulation (COH) using GnRH antagonists. The key points covered include:
1) The importance of LH suppression in COH to prevent premature luteinization and improve outcomes.
2) How GnRH antagonists can be used for LH suppression compared to agonists. Clinical trials show antagonists reduce OHSS risk and duration of stimulation compared to agonists without impacting live birth rates.
3) Flexible or fixed antagonist protocols, use of oral contraceptives, and timing of hCG administration do not significantly impact outcomes. LH supplementation is generally not needed.
Update on LETROZOLE Current Guidelines for Ovulation Induction Dr. Sharda Jain Lifecare Centre
Update on LETROZOLE Current Guidelines for Ovulation Induction
LET NOT FORGET
WHY
??
LETROZOLE was withdrawn from
Indian market (2012)
“SAFETY ISSUES”
“Could Be Teratogenic In Human”?
This document discusses the management of poor or hyper ovarian response in IVF treatment. It covers topics such as predicting ovarian reserve, definitions of poor response, protocols for poor and hyper responders, and techniques like coasting to help prevent ovarian hyperstimulation syndrome. Coasting, where gonadotropin administration is stopped but down regulation continued, is an effective way to prevent OHSS while still allowing for embryo retrieval and transfer. GnRH antagonist protocols may also help lower the risk of OHSS compared to long agonist protocols. There is no single best protocol, and treatments should be individualized based on patient factors and expectations.
Letrozole is an aromatase inhibitor that is an effective alternative to clomiphene citrate for ovulation induction. It has several advantages over clomiphene citrate including oral administration, lower risk of multiple pregnancies and miscarriage, and no antiestrogenic effects on the endometrium or cervical mucus. Studies show letrozole results in higher ovulation and pregnancy rates compared to clomiphene citrate. When used as an adjuvant to gonadotropins, letrozole reduces gonadotropin dosage and improves outcomes. Letrozole may help improve IVF success rates in poor responders by enhancing follicular response to gonadotropins and lowering estrogen
Role of adjuvants in poor ovarian responders , undergoing infertility treatment , in terms of Intra uterine inseminations ( IUI ) to In Vitro Fertilization ( IVF )
This document discusses the use of letrozole for ovulation induction. It begins by explaining how letrozole works at a molecular level to stimulate follicular growth, noting key differences from clomiphene citrate such as not blocking estrogen receptors and maintaining feedback inhibition. Clinical studies are then summarized finding letrozole to have higher ovulation and live birth rates than clomiphene citrate, especially in women with PCOS or who are clomiphene citrate resistant. The document concludes by stating letrozole has been used successfully for ovulation induction in PCOS, intrauterine insemination, and ovarian stimulation for IVF/ICSI.
GnRH Antagonists in Controlled Ovarian StimulationSandro Esteves
This document provides an overview of a lecture on LH suppression in controlled ovarian hyperstimulation (COH) using GnRH antagonists. The key points covered include:
1) The importance of LH suppression in COH to prevent premature luteinization and improve outcomes.
2) How GnRH antagonists can be used for LH suppression compared to agonists. Clinical trials show antagonists reduce OHSS risk and duration of stimulation compared to agonists without impacting live birth rates.
3) Flexible or fixed antagonist protocols, use of oral contraceptives, and timing of hCG administration do not significantly impact outcomes. LH supplementation is generally not needed.
Update on LETROZOLE Current Guidelines for Ovulation Induction Dr. Sharda Jain Lifecare Centre
Update on LETROZOLE Current Guidelines for Ovulation Induction
LET NOT FORGET
WHY
??
LETROZOLE was withdrawn from
Indian market (2012)
“SAFETY ISSUES”
“Could Be Teratogenic In Human”?
This document discusses the management of poor or hyper ovarian response in IVF treatment. It covers topics such as predicting ovarian reserve, definitions of poor response, protocols for poor and hyper responders, and techniques like coasting to help prevent ovarian hyperstimulation syndrome. Coasting, where gonadotropin administration is stopped but down regulation continued, is an effective way to prevent OHSS while still allowing for embryo retrieval and transfer. GnRH antagonist protocols may also help lower the risk of OHSS compared to long agonist protocols. There is no single best protocol, and treatments should be individualized based on patient factors and expectations.
Letrozole is an aromatase inhibitor that is an effective alternative to clomiphene citrate for ovulation induction. It has several advantages over clomiphene citrate including oral administration, lower risk of multiple pregnancies and miscarriage, and no antiestrogenic effects on the endometrium or cervical mucus. Studies show letrozole results in higher ovulation and pregnancy rates compared to clomiphene citrate. When used as an adjuvant to gonadotropins, letrozole reduces gonadotropin dosage and improves outcomes. Letrozole may help improve IVF success rates in poor responders by enhancing follicular response to gonadotropins and lowering estrogen
Role of adjuvants in poor ovarian responders , undergoing infertility treatment , in terms of Intra uterine inseminations ( IUI ) to In Vitro Fertilization ( IVF )
Luteal phase support in ART Cases Dr Sharda Jain Lifecare Centre
The document discusses luteal phase support in assisted reproductive technology (ART) cycles. It provides 3 key points:
1. Luteal phase deficiency is common in ART cycles due to multiple factors like multifollicular development and aspiration of granulosa cells, leading to premature luteolysis and defective progesterone secretion.
2. Progesterone supplementation is important for luteal phase support as progesterone prepares the endometrium, decreases uterine contractility, and regulates immunity - all of which are important for embryo implantation and maintenance of early pregnancy.
3. Oral dydrogesterone is recommended for luteal phase support in ART cycles due to its greater bioavailability allowing the use of lower doses, minimal side effects
Since the first formal description of LPD in 1949 as a possible cause of infertility and recurrent miscarriage by Jones. Innumerable investigations have been undertaken in an effort to verify its existence or to characterize its pathophysiology, diagnosis, and treatment. The consensus of the literature is that LPD does exist and that its cause is multifactorial like abnormal folliculogenesis, inadequate LH surge,inadequate secretion of progesterone by the corpus luteum, aberrant end-organ response by the endometrium.
This document contains information from Dr. Shashwat Jani regarding ovarian stimulation protocols for IUI. It discusses various stimulation options including clomiphene citrate, letrozole, gonadotropins, and combinations. It provides details on dosing, monitoring, and the advantages and disadvantages of different protocols. The goal of stimulation is to develop multiple follicles to improve pregnancy rates with IUI or develop a single follicle for anovulatory patients.
This document discusses the definition and management of poor responders in IVF treatment. It begins by outlining the ESHRE consensus definition of a poor responder as having two of three features: advanced maternal age, a previous poor response, or an abnormal ovarian reserve test. It then lists factors that can predict a poor response such as AFC, AMH, ovarian volume, and prior poor response. The document discusses precyle adjuvants like DHEA supplementation, cyst drainage, and oral contraceptives. It also reviews stimulation protocols including agonist versus antagonist, natural cycle IVF, and dosing intervals. Laboratory options for poor responders like ICSI, PGS, and embryo transfer timing are discussed. The role of donor
Invited Lecture delivered by Dr Sujoy Dasgupta in the Annual Conference of ISAR (Indian Society of Assisted Reproduction) held at Kolkata in November, 2019
Ovarian reserve refers to the reproductive potential left within a woman's two ovaries based on number and quality of eggs. Diminished ovarian reserve is the loss of normal reproductive potential in the ovaries due to a lower count or quality of the remaining eggs
Dr Parul Katiyar discusses simple strategies to optimize clinical outcome of Intra Uterine Insemination (IUI). She talks about the importance of appropriate patient selection and choosing the correct stimulation protocol, among other factors.
The document discusses management strategies for poor responders undergoing assisted reproductive technology. It begins by defining poor responders according to the Bologna criteria and shows how live birth rates decrease significantly with fewer oocytes retrieved. It then outlines an approach to managing poor responders that includes identifying at-risk patients using biomarkers like AMH, individualizing controlled ovarian stimulation protocols, optimizing lab procedures, and tailoring embryo transfer. Specific strategies discussed include using gonadotropins like recombinant FSH, adding LH supplementation, antagonist protocols, and minimal stimulation approaches.
The document discusses changing protocols for in vitro fertilization (IVF) from gonadotropin-releasing hormone (GnRH) agonists to GnRH antagonists. Some key points discussed include:
1) GnRH antagonists are associated with a lower risk of ovarian hyperstimulation syndrome (OHSS) compared to GnRH agonists.
2) While efficacy outcomes like live birth and pregnancy rates are similar between the two protocols, GnRH antagonists require fewer gonadotropin ampoules and have a shorter duration of stimulation.
3) Based on multiple randomized controlled trials and meta-analyses, it is justified to shift from GnRH agonists to GnRH antagonists for IVF
This document discusses ovulation induction for intrauterine insemination (IUI). It aims to recruit multiple follicles, overcome subtle endocrine issues, prevent luteinizing hormone surges, assess ovulation timing, and increase the probability of conception with minimal risk of ovarian hyperstimulation. Drugs discussed include clomiphene citrate, aromatase inhibitors, gonadotropins, and gonadotropin-releasing hormone agonists/antagonists. Optimal stimulation criteria, drug costs, predictors of response and poor response, and trigger timing are also covered. Case studies examine treatment protocols for specific patient profiles.
The document discusses luteal phase support (LPS) in assisted reproductive technology (ART) cycles. It notes that abnormal luteal function can occur after controlled ovarian stimulation, necessitating LPS. It reviews various LPS options including human chorionic gonadotropin and progesterone administered via different routes. Vaginal progesterone is found to effectively increase endometrial levels while intramuscular progesterone yields the highest serum levels. The document concludes that LPS is necessary to optimize ART outcomes and that intramuscular or vaginal progesterone are equally effective options.
Ovulation Induction in I.U.I. Dr. Sharda Jain Dr. Jyoti Agarwal Dr. Jyoti Bh...Lifecare Centre
Letrozole is an aromatase inhibitor that has been shown to be effective for ovulation induction. It works by decreasing estrogen production in the ovaries. Some advantages of letrozole over clomiphene citrate include shorter half-life, lack of anti-estrogenic effects on the endometrium and cervical mucus, increased uterine blood flow, and lower risks of multiple pregnancy and OHSS. Common side effects include hot flashes and headaches. Guidelines from several medical societies recommend letrozole as a first-line treatment for ovulation induction in women with PCOS. The starting dose is typically 2.5 mg daily for 5 days, but step-up protocols have also shown effectiveness.
DHEA supplementation can improve ovarian reserve and fertility outcomes in women with diminished ovarian reserve. It acts early in follicle development to stimulate growth and maturation. Studies show DHEA increases levels of AMH, the number of eggs and embryos retrieved in IVF, and pregnancy rates while decreasing cancellation rates. The optimal dosage is 25mg three times daily until pregnancy is achieved. DHEA is not recommended for PCOS patients unless they have low testosterone levels and are poor responders.
Evidence for a significant effect in favor of progesterone for luteal phase support. Best result with synthe7c progesterone.
• Evidence that the addi7on of othe substances such as estrogen or hCG doe not improve outcomes.
• Evidence for equivalence of IM and vaginal routes of administra7on. Vaginal route is best tolerated by pa7ents.
• hCG, or hCG plus progesterone, was associated with a higher risk of OHSS. The use of hCG should therefore be avoided.
• Evidence showing a benefit from the addi7on of GnRH agonist to progesterone in luteal phase support
Ivf stimulation protocols by Dr. Mahalakshmi SaravananMorris Jawahar
This document discusses the evolution of ovarian stimulation protocols for in vitro fertilization (IVF). It notes that while the first IVF baby was born from a natural cycle, stimulation was later adopted to increase egg retrieval and IVF success rates. Problems with early follicle selection and ovulation timing necessitated the use of gonadotropin-releasing hormone (GnRH) agonists and antagonists to suppress the pituitary gland and allow for synchronous follicle development and controlled oocyte retrieval. Modern stimulation protocols use exogenous gonadotropins during follicle recruitment and pituitary suppression to interfere with the natural follicle selection process and enable multiple follicle development.
1) Luteal phase support is important for assisted reproduction cycles to ensure adequate progesterone levels and proper endometrial development.
2) Progesterone supplementation is generally recommended, with micronized progesterone or dydrogesterone being good options. Vaginal administration is equally effective as intramuscular with fewer side effects.
3) Progesterone should be started 24-48 hours after egg retrieval/release and continued until 9 weeks of pregnancy. The addition of a single GnRH agonist dose may further improve outcomes. hCG is not recommended due to risk of OHSS.
Dr. Sunita Chandra is the Chairperson and Director of Rajendra Nagar Hospital & IVF Centre and Director of Morpheus Lucknow Fertility Centre. She has extensive training and experience in fertility and IVF in India and Germany. She has published research papers and book chapters on fertility-related topics. She has held several leadership roles in fertility-related organizations and has spoken at numerous national and international conferences. She has received several awards for her contributions to medicine and healthcare in Uttar Pradesh.
The clinical approach to ovulation induction requires an
understanding of the causes of anovulation. Check my detailed presentation to get detailed understanding.
Letrozole in assisted reproduction , Prof. Usama M. Foudaumfrfouda
Letrozole is an aromatase inhibitor that is effective for ovulation induction. It works by decreasing estrogen levels and increasing FSH levels, stimulating follicle growth. Studies have shown letrozole to be as effective as clomiphene citrate for inducing ovulation in women with PCOS or unexplained infertility. Letrozole may also improve ovarian response and decrease gonadotropin needs when used as an adjuvant to gonadotropins for ovarian stimulation in IVF. Letrozole is a promising option for fertility preservation in cancer patients undergoing IVF since it maintains lower estrogen levels than standard gonadotropin protocols.
Luteal phase support in ART Cases Dr Sharda Jain Lifecare Centre
The document discusses luteal phase support in assisted reproductive technology (ART) cycles. It provides 3 key points:
1. Luteal phase deficiency is common in ART cycles due to multiple factors like multifollicular development and aspiration of granulosa cells, leading to premature luteolysis and defective progesterone secretion.
2. Progesterone supplementation is important for luteal phase support as progesterone prepares the endometrium, decreases uterine contractility, and regulates immunity - all of which are important for embryo implantation and maintenance of early pregnancy.
3. Oral dydrogesterone is recommended for luteal phase support in ART cycles due to its greater bioavailability allowing the use of lower doses, minimal side effects
Since the first formal description of LPD in 1949 as a possible cause of infertility and recurrent miscarriage by Jones. Innumerable investigations have been undertaken in an effort to verify its existence or to characterize its pathophysiology, diagnosis, and treatment. The consensus of the literature is that LPD does exist and that its cause is multifactorial like abnormal folliculogenesis, inadequate LH surge,inadequate secretion of progesterone by the corpus luteum, aberrant end-organ response by the endometrium.
This document contains information from Dr. Shashwat Jani regarding ovarian stimulation protocols for IUI. It discusses various stimulation options including clomiphene citrate, letrozole, gonadotropins, and combinations. It provides details on dosing, monitoring, and the advantages and disadvantages of different protocols. The goal of stimulation is to develop multiple follicles to improve pregnancy rates with IUI or develop a single follicle for anovulatory patients.
This document discusses the definition and management of poor responders in IVF treatment. It begins by outlining the ESHRE consensus definition of a poor responder as having two of three features: advanced maternal age, a previous poor response, or an abnormal ovarian reserve test. It then lists factors that can predict a poor response such as AFC, AMH, ovarian volume, and prior poor response. The document discusses precyle adjuvants like DHEA supplementation, cyst drainage, and oral contraceptives. It also reviews stimulation protocols including agonist versus antagonist, natural cycle IVF, and dosing intervals. Laboratory options for poor responders like ICSI, PGS, and embryo transfer timing are discussed. The role of donor
Invited Lecture delivered by Dr Sujoy Dasgupta in the Annual Conference of ISAR (Indian Society of Assisted Reproduction) held at Kolkata in November, 2019
Ovarian reserve refers to the reproductive potential left within a woman's two ovaries based on number and quality of eggs. Diminished ovarian reserve is the loss of normal reproductive potential in the ovaries due to a lower count or quality of the remaining eggs
Dr Parul Katiyar discusses simple strategies to optimize clinical outcome of Intra Uterine Insemination (IUI). She talks about the importance of appropriate patient selection and choosing the correct stimulation protocol, among other factors.
The document discusses management strategies for poor responders undergoing assisted reproductive technology. It begins by defining poor responders according to the Bologna criteria and shows how live birth rates decrease significantly with fewer oocytes retrieved. It then outlines an approach to managing poor responders that includes identifying at-risk patients using biomarkers like AMH, individualizing controlled ovarian stimulation protocols, optimizing lab procedures, and tailoring embryo transfer. Specific strategies discussed include using gonadotropins like recombinant FSH, adding LH supplementation, antagonist protocols, and minimal stimulation approaches.
The document discusses changing protocols for in vitro fertilization (IVF) from gonadotropin-releasing hormone (GnRH) agonists to GnRH antagonists. Some key points discussed include:
1) GnRH antagonists are associated with a lower risk of ovarian hyperstimulation syndrome (OHSS) compared to GnRH agonists.
2) While efficacy outcomes like live birth and pregnancy rates are similar between the two protocols, GnRH antagonists require fewer gonadotropin ampoules and have a shorter duration of stimulation.
3) Based on multiple randomized controlled trials and meta-analyses, it is justified to shift from GnRH agonists to GnRH antagonists for IVF
This document discusses ovulation induction for intrauterine insemination (IUI). It aims to recruit multiple follicles, overcome subtle endocrine issues, prevent luteinizing hormone surges, assess ovulation timing, and increase the probability of conception with minimal risk of ovarian hyperstimulation. Drugs discussed include clomiphene citrate, aromatase inhibitors, gonadotropins, and gonadotropin-releasing hormone agonists/antagonists. Optimal stimulation criteria, drug costs, predictors of response and poor response, and trigger timing are also covered. Case studies examine treatment protocols for specific patient profiles.
The document discusses luteal phase support (LPS) in assisted reproductive technology (ART) cycles. It notes that abnormal luteal function can occur after controlled ovarian stimulation, necessitating LPS. It reviews various LPS options including human chorionic gonadotropin and progesterone administered via different routes. Vaginal progesterone is found to effectively increase endometrial levels while intramuscular progesterone yields the highest serum levels. The document concludes that LPS is necessary to optimize ART outcomes and that intramuscular or vaginal progesterone are equally effective options.
Ovulation Induction in I.U.I. Dr. Sharda Jain Dr. Jyoti Agarwal Dr. Jyoti Bh...Lifecare Centre
Letrozole is an aromatase inhibitor that has been shown to be effective for ovulation induction. It works by decreasing estrogen production in the ovaries. Some advantages of letrozole over clomiphene citrate include shorter half-life, lack of anti-estrogenic effects on the endometrium and cervical mucus, increased uterine blood flow, and lower risks of multiple pregnancy and OHSS. Common side effects include hot flashes and headaches. Guidelines from several medical societies recommend letrozole as a first-line treatment for ovulation induction in women with PCOS. The starting dose is typically 2.5 mg daily for 5 days, but step-up protocols have also shown effectiveness.
DHEA supplementation can improve ovarian reserve and fertility outcomes in women with diminished ovarian reserve. It acts early in follicle development to stimulate growth and maturation. Studies show DHEA increases levels of AMH, the number of eggs and embryos retrieved in IVF, and pregnancy rates while decreasing cancellation rates. The optimal dosage is 25mg three times daily until pregnancy is achieved. DHEA is not recommended for PCOS patients unless they have low testosterone levels and are poor responders.
Evidence for a significant effect in favor of progesterone for luteal phase support. Best result with synthe7c progesterone.
• Evidence that the addi7on of othe substances such as estrogen or hCG doe not improve outcomes.
• Evidence for equivalence of IM and vaginal routes of administra7on. Vaginal route is best tolerated by pa7ents.
• hCG, or hCG plus progesterone, was associated with a higher risk of OHSS. The use of hCG should therefore be avoided.
• Evidence showing a benefit from the addi7on of GnRH agonist to progesterone in luteal phase support
Ivf stimulation protocols by Dr. Mahalakshmi SaravananMorris Jawahar
This document discusses the evolution of ovarian stimulation protocols for in vitro fertilization (IVF). It notes that while the first IVF baby was born from a natural cycle, stimulation was later adopted to increase egg retrieval and IVF success rates. Problems with early follicle selection and ovulation timing necessitated the use of gonadotropin-releasing hormone (GnRH) agonists and antagonists to suppress the pituitary gland and allow for synchronous follicle development and controlled oocyte retrieval. Modern stimulation protocols use exogenous gonadotropins during follicle recruitment and pituitary suppression to interfere with the natural follicle selection process and enable multiple follicle development.
1) Luteal phase support is important for assisted reproduction cycles to ensure adequate progesterone levels and proper endometrial development.
2) Progesterone supplementation is generally recommended, with micronized progesterone or dydrogesterone being good options. Vaginal administration is equally effective as intramuscular with fewer side effects.
3) Progesterone should be started 24-48 hours after egg retrieval/release and continued until 9 weeks of pregnancy. The addition of a single GnRH agonist dose may further improve outcomes. hCG is not recommended due to risk of OHSS.
Dr. Sunita Chandra is the Chairperson and Director of Rajendra Nagar Hospital & IVF Centre and Director of Morpheus Lucknow Fertility Centre. She has extensive training and experience in fertility and IVF in India and Germany. She has published research papers and book chapters on fertility-related topics. She has held several leadership roles in fertility-related organizations and has spoken at numerous national and international conferences. She has received several awards for her contributions to medicine and healthcare in Uttar Pradesh.
The clinical approach to ovulation induction requires an
understanding of the causes of anovulation. Check my detailed presentation to get detailed understanding.
Letrozole in assisted reproduction , Prof. Usama M. Foudaumfrfouda
Letrozole is an aromatase inhibitor that is effective for ovulation induction. It works by decreasing estrogen levels and increasing FSH levels, stimulating follicle growth. Studies have shown letrozole to be as effective as clomiphene citrate for inducing ovulation in women with PCOS or unexplained infertility. Letrozole may also improve ovarian response and decrease gonadotropin needs when used as an adjuvant to gonadotropins for ovarian stimulation in IVF. Letrozole is a promising option for fertility preservation in cancer patients undergoing IVF since it maintains lower estrogen levels than standard gonadotropin protocols.
This document discusses the use of letrozole for fertility treatments. It begins with an introduction and outline on polycystic ovary syndrome (PCOS), unexplained infertility, fertility preservation for breast cancer patients, frozen embryo transfer, and decreasing ovarian hyperstimulation syndrome (OHSS). It then goes into more detail on each topic, providing evidence from randomized controlled trials, meta-analyses, and clinical guidelines that letrozole results in higher pregnancy and live birth rates compared to clomiphene citrate for PCOS and unexplained infertility. It also discusses how letrozole can be used during fertility preservation for breast cancer patients to prevent high estrogen levels. The document concludes by stating letrozole may
Role of progestogens in obstetrics and gynecologyAhmad Saber
The
different progestogens with their overlapping effects on estrogen, androgen, glucocorticoid,
and mineralocorticoid receptors are described in order to allow the clinician to make the most appropriate choice of progestogen.
Aromatase inhibitors like letrozole are effective alternatives to clomiphene citrate for ovulation induction and superovulation. Studies have shown ovulation rates of 70-84% and pregnancy rates of 20-27% per cycle with letrozole for ovulation induction in anovulatory women. For superovulation, letrozole results in fewer follicles than gonadotropins but a higher pregnancy rate than clomiphene citrate. Aromatase inhibitors do not have the antiestrogenic side effects of clomiphene citrate on the endometrium. Given their advantages over clomiphene citrate, aromatase inhibitors may replace it as the standard treatment for ovulation disorders
Adjuvant therapy, also known as adjunct therapy or add-on therapy, is therapy given in addition to the primary or initial therapy to maximize its effectiveness.
Add-ons have become ubiquitous with the process of assisted reproduction (ART) which is markedly more complex than it was at its inception.
This document discusses issues related to women with epilepsy, including:
- About half of women with epilepsy are of reproductive age. Enzyme-inducing antiepileptic drugs can reduce the effectiveness of contraceptives.
- Catamenial epilepsy involves seizures related to the menstrual cycle. Hormonal treatments like progesterone can help control seizures.
- Epilepsy during pregnancy presents challenges of balancing seizure control and risks of medication. Risks include fetal malformations, developmental effects, and pregnancy complications. Lower-risk drugs include lamotrigine and levetiracetam. Frequent monitoring is important.
- Pregnancy can impact epilepsy through hormonal changes and drug level fluctuations requiring dose adjustments
Medical Management of Fibroids, Dr. Sharda Jain Lifecare Centre
This document discusses the medical management of uterine fibroids. It begins by providing background on fibroids, their prevalence, and classification systems. It then discusses various medical treatment options for fibroids including hormonal therapies like combined oral contraceptives, progestin-only pills, and levonorgestrel intrauterine devices. Other options covered include gonadotropin-releasing hormone agonists and antagonists, progesterone receptor modulators like ulipristal acetate and mifepristone, and androgenic steroids. It notes the effectiveness and side effects of these various treatments and concludes that while medical options provide symptom relief, treatment is still evolving with no definitive solution.
The document discusses progestogens, which include progesterone and synthetic progestins. Progesterone is secreted naturally, while progestins have progesterone-like effects. Both are used for obstetric and gynecologic purposes. Therapeutically, progestogens are used to support early pregnancy, treat menstrual disorders, provide luteal phase support in assisted reproduction, and relieve symptoms of conditions like endometriosis. While generally effective, studies on uses like threatened miscarriage and preterm labor have been limited by small sample sizes. Natural progesterone generally has fewer side effects than progestins. The document examines various progestogen types and routes of administration.
This document summarizes current evidence on medical add-ons used in in vitro fertilization (IVF). It discusses adjuvants used to improve ovarian response and implantation success, including DHEA, growth hormone, antioxidants, artificial oocyte activation, estrogen, and metformin. For each adjuvant, the proposed mechanisms of action and available evidence from studies are summarized. In general, the evidence for most add-ons is limited and inconclusive due to small study sizes and heterogeneity. High-quality randomized controlled trials are still needed to establish efficacy and safety.
LETROZOLE - A WONDER DRUG FOR OVULATION INDUCTION BY DR SHASHWAT JANIDR SHASHWAT JANI
Letrozole is an aromatase inhibitor that has been used as an alternative to clomiphene citrate for ovulation induction in women with infertility. It works by inhibiting the aromatase enzyme, reducing estrogen levels and allowing for increased FSH production and dominant follicle development. Studies have shown letrozole to be as effective as clomiphene citrate in ovulation and pregnancy rates. While initial studies raised safety concerns for babies exposed to letrozole, larger subsequent studies found no increased risk of birth defects compared to clomiphene citrate or the general population. Letrozole is now a widely accepted treatment for ovulation induction and infertility.
Premature ovarian failure (POF) by istandawoodsalim3
This document discusses ovarian reserve and primary ovarian insufficiency (POI). It defines POI as the exhaustion of ovarian function prior to age 40, characterized by menstrual disturbances and high gonadotropins and low estrogen. POI prevalence is estimated at 1-2% of the population. Causes may include autoimmune, genetic, infectious, or idiopathic factors. Diagnosis is based on menstrual disturbances and elevated FSH levels. POI has widespread health consequences and fertility implications, so investigation of causes and fertility preservation options should be considered. Hormone replacement therapy is recommended for POI patients to treat low estrogen symptoms and provide long term health benefits.
The document discusses various tests used to assess ovarian reserve. It describes anti-Mullerian hormone (AMH) as the most sensitive marker that declines with age and correlates with antral follicle count (AFC). Basal follicle-stimulating hormone (FSH) levels increase with declining reserve but have inter-cycle variability. AFC counts the number of antral follicles and correlates with ovarian response, though cut-offs vary. No single test can reliably predict fertility or treatment response on its own.
This document discusses obesity, systemic lupus erythematosus (SLE), thyroid disease, and in vitro fertilization (IVF). It summarizes that obesity is associated with lower clinical pregnancy and live birth rates after IVF due to factors like insulin resistance and inflammation. For SLE patients undergoing IVF, aggressive ovarian stimulation should be avoided to prevent thrombosis, and immunosuppressants may be increased. Thyroid disorders must be controlled before conception, and levothyroxine doses may need adjustment during ovarian stimulation due to changes in hormone levels. Screening for thyroid disease is recommended for those with risk factors prior to IVF to optimize treatment.
Laparoscopic ovarian drilling (LOD) is a surgical treatment for polycystic ovary syndrome (PCOS) that involves using cautery or a laser to puncture the ovaries. It was developed as an alternative to ovarian wedge resection. The main indications for LOD are PCOS patients who are clomiphene citrate-resistant and infertile. LOD works by reducing androgen levels and restoring the hypothalamic-pituitary-ovarian axis. It has been shown to induce ovulation and increase pregnancy rates in many PCOS patients. While complications can include bleeding, adhesion formation, and potential risks to ovarian reserve, LOD remains an effective second-line treatment for infertility in appropriately selected PCOS
This document discusses infertility evaluation and treatment. It begins by outlining factors to consider before trying to conceive and describing methods for timing intercourse. Common causes of infertility include problems with ovulation, male factor issues, and tubal or uterine abnormalities. Treatment options range from lifestyle changes to assisted reproductive technologies like intrauterine insemination, ovulation induction, and in vitro fertilization. While assisted reproduction can help many couples conceive, it may also lead to multiple births and there are still some unknown risks for children conceived through these methods.
Fertility, Pregnancy, Contraception, Lactation And Endocrine Therapy In Breas...Mamdouh Sabry
Discussing every detail concerning gynaecologist and obstetrician in breast cancer. As fertility, pregnancy outcome, contraception, lactation, adjuvant hormone therapy and prevention.
Similar to LETROZOLE IN THE MANAGEMENT OF INFERTILITY (20)
Artificial intelligence and reproductive Medicine.pptxG A RAMA Raju
PowerPoint slides and provides an overview of the critical role of AI in reproductive medicine. It highlights the technological advancements, case studies, and ethical considerations, painting a comprehensive picture of this exciting intersection of technology and healthcare.
Describes tThe precise dosage and duration of progesterone administration for luteal support in IVF are still topics of ongoing research, which could potentially lead to suboptimal outcomes such as miscarriage or preterm birth if not correctly managed.The efficacy of progesterone in reducing miscarriage and preterm birth rates in IVF, creating uncertainty about the best approach to luteal phase support.
Current trends in embryology- role of Time-lapse embryo monitoring .pptxG A RAMA Raju
. Time-lapse embryo monitoring is a compact modular benchtop incubator that incorporates time-lapse imaging to capture critical developmental stages of embryo development. Designed to offer an individualized and undisturbed incubation, the time-lapse incubator provides stable culture conditions in an optimal environment.#geri
#krishnaivf
Can time lapse incubation and monitoring be beneficial for art monitoring in ...G A RAMA Raju
After close to 45 years of assisted reproduction and a glance back at what are major milestones had impacted the practice of assisted reproduction. The first is the birth of Louis brown in 1978. A decade and a half later, the advent of icsi, tese icsi, has changed the management of male factor infertility. A decade later, in the early 2000s, we had the vitrification initially of the embryos, latter oocyte, and reproductive tissue. Now maybe we are. on the threshold of another revolution, and this time into ivf laboratory where the closed door of embryo development has to be opened to the miracle of early human embryology development through time-lapse embryo monitoring. This presentation walks you through the development
1) The document discusses using 3D ultrasound to evaluate the uterus in four dimensions, including the myometrial architecture, junctional zone, endometrial cavity, and endometrial architecture.
2) Abnormalities that can be identified include developmental abnormalities of the uterus, myometrial abnormalities like adenomyosis, endometrial abnormalities like polyps, and iatrogenic issues like C-section scars.
3) 3D ultrasound can provide detailed information on the uterine and placental vasculature that 2D ultrasound cannot, and help identify vascular abnormalities like AV malformations that can impact fertility.
The presentation is about male factor infertility.
Absence of sperms, also known as Azoospermia. The treatments of an Azoospermia had changed a lot in the last 25 years starting in 1995 when the first successful case of non-obstructive Azooxpermia was published in the journal of human reproduction. This lecture elaborates on the various methods that are used for obtaining sperm from the testis and also explains the current progress happening in this field of stem cells in the management of males. Infertility,
Lh in assisted reproduction by DR G A RAMARAJUG A RAMA Raju
Luteinizing hormone (LH) in synergy with follicle stimulating hormone (FSH) stimulates normal follicular growth and ovulation. FSH is frequently used in assisted reproductive technology (ART). Recent studies have facilitated better understanding on the complementary role of the LH to FSH in regulation of the follicle; however, role of LH in stimulation of follicle, optimal dosage of LH in stimulation and its importance in advanced aged patients has been a topic of discussion among medical fraternity. Though the administration of exogenous LH with FSH is obligatory for controlled ovarian stimulation in patients with hypogonadotropic hypogonadism, there is still a paucity of information of its usage in other patient population.A Brief introduction of Lh polymorphism in ovarian stimulation
DEALING WITH ART FAILURE – what should be the stimulation we offerG A RAMA Raju
This document discusses various topics related to dealing with ART (assisted reproductive technology) failure, including potential stimulation options and factors to consider. It addresses empty follicle syndrome diagnosis and causes. Poor versus hypo-responder differences and options for each are outlined. The role of LH supplementation for hypo-responders is discussed. Ongoing debates around optimal versus excessive egg yields and coasting for hyper-responders are also summarized. Genetic factors like LHCGR and FSH receptor polymorphisms that could influence treatment are mentioned.
1. The document discusses measuring progesterone levels during IVF treatment and the role of progesterone in implantation.
2. There is debate around what progesterone levels indicate successful implantation, with some studies finding levels above 1.0 or 1.5 ng/ml can negatively impact outcomes, while others find higher thresholds.
3. Accurately measuring progesterone is challenging due to issues with assays, sample handling, and lack of standards between clinics. Establishing a standardized reference level could help improve IVF success rates.
This document discusses the rationale for using luteinizing hormone (LH) for ovulation induction and superovulation. It notes that LH plays an important role in the mid-follicular phase by regulating theca cell function and androgen production, which is necessary for follicular development. The concept of an optimal "therapeutic window" of LH levels is introduced, with both insufficient and excessive LH being detrimental to follicular growth and oocyte maturation. Certain patient groups, such as poor responders, older women, and those with LH polymorphisms, may benefit from LH supplementation during assisted reproductive technology cycles to improve outcomes.
This document discusses the evaluation of male infertility, which is often neglected. It outlines the components of a complete evaluation, including history, physical exam, semen analysis, imaging, and hormonal and genetic testing. Lifestyle factors like smoking, alcohol, obesity, medications, and environmental exposures can negatively impact fertility. A physical exam evaluates secondary sex characteristics, genitals, and tests for issues like varicocele. Semen analysis assesses volume, concentration, motility, and morphology. Additional tests may include ultrasounds, hormone levels, sperm DNA fragmentation, and genetic testing. Finding the cause of infertility helps determine the best treatment approach.
This document discusses the use of recombinant luteinizing hormone (rLH) in assisted reproduction. It begins by asking if an appropriate patient population has been defined that could benefit from rLH supplementation. It then discusses LH and FSH action on follicles, the LH therapeutic window concept, and how central nervous system influence can cause hypothalamic-pituitary-hypogonadism. The document presents studies showing improved follicular development and outcomes like pregnancy rates with the addition of rLH for poor responders and women over 35 undergoing fertility treatments. It also discusses dose-finding studies that identified a safe and effective dose of 75IU/day rLH. In conclusion, the risks of rLH supplementation are addressed as
This document discusses techniques for improving embryo transfer in IVF procedures. It recommends:
1) Proper evaluation of the uterine cavity and removal of cervical mucus to minimize trauma and avoid uterine contractions.
2) The use of soft catheters and avoiding negative pressure from the catheter to prevent complications.
3) Completing the procedure in a timely manner to increase chances of success.
This document summarizes key concepts in vitrification and cryobiology. It discusses the components involved in vitrification including cryoprotectants like sucrose, ethylene glycol, DMSO, and propylene glycol. It outlines the steps in vitrification - adding cryoprotectants, cooling cells to -196C, warming/thawing, and removing cryoprotectants. Variables that can influence vitrification effectiveness are discussed. Composition of vitrification and warming solutions from different studies are presented. Similar survival rates between vitrification and slow freezing are noted. Open questions around water removal from oocytes during vitrification are raised. The need for long term follow up studies on neonatal outcomes is emphasized.
This document discusses polycystic ovary syndrome (PCOS) and its implications. It begins with the diagnostic criteria for PCOS including hyperandrogenism, oligo/amenorrhea, and polycystic ovaries. It then covers the diagnostic workup involving physical exams, laboratory tests, ultrasound, and optional tests. The document discusses the implications of PCOS for health including metabolic syndrome and future cardiovascular risks. It covers the implications for infertility such as treatments including lifestyle changes, clomiphene citrate, gonadotropins, laparoscopic ovarian drilling, metformin, and assisted reproduction. The implications for pregnancy with PCOS including gestational diabetes, pregnancy induced hypertension, preterm birth, birth weight,
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These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
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• Pitfalls and pivots needed to use AI effectively in public health
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3. Contents
HISTORY LEGALITY IDEAL OVULATION
INDUCTION DRUG
MECHANISM OF ACTION
DIFFERENCE BETWEEN CC
AND LETROZOLE
GROUND BREAKING
ARTICLE
TREATMENT OPTIONS FOR
INFERTILITY
GUIDELINES
DIFFERENT TYPES OF
INFERTILITY SUMMARY
4. Estimates of infertility vary widely among Indian states from
Prevalence of primary infertility in India is between 3.9 & 16.8 affecting about
12 million couples!
5 in Andhra
Pradesh
3.7 per cent in
Uttar Pradesh,
Himachal Pradesh
and Maharashtra
15 in
Kashmir
5. DICOVERY & ROLE OF AROMATASE INHIBITORS
Angela-brodie
If you have something you think
is a good idea, stick to it,”
11. Ideal Ovulation Induction Drug
Oral administration Minimal monitoring of the cycle
No hostile effect on the
endometrium and cervical
mucus
Better ovulation rate and
pregnancy rate
Less risk of OHSS and multiple
pregnancy
Requena A, Herrero J, Landeras J, Navarro E, Neyro J, Salvador C et al. Use of letrozole in assisted reproduction: a
systematic review and meta-analysis. Human Reproduction Update. 2008;14(6):571-582.
12. Aromatase Inhibitor
• Inhibit or inactivate Aromatase
• Aromatase
–Cytochrome P-450 superfamily
–CYP19 gene
–Rate limiting step in estrogen production, that
is, conversion of androgens (androstenedione
and testosterone) into estrogens (estrone and
estradiol, respectively).
Requena A, Herrero J, Landeras J, Navarro E, Neyro J, Salvador C et al. Use of letrozole in assisted reproduction: a
systematic review and meta-analysis. Human Reproduction Update. 2008;14(6):571-582.
13. Classification of aromatase inhibitors
SECOND
GENERATION
3 rd.
GENERATION
LETROZOLE
Requena A, Herrero J, Landeras J, Navarro E, Neyro J, Salvador C et al. Use of letrozole in assisted reproduction: a
systematic review and meta-analysis. Human Reproduction Update. 2008;14(6):571-582.
20. Clarification article
In this double-blind, multicentre trial, authors randomly assigned 750 women, in a 1:1 ratio, to
receive letrozole or clomiphene for up to five treatment cycles, with visits to determine ovulation and
pregnancy, followed by tracking of pregnancies
N Engl J Med 2014;371:119-29
21. Outcomes with Regard to Live Birth, Ovulation, Pregnancy,
Pregnancy Loss, and Fecundity.
N Engl J Med 2014;371:119-29
23. Adverse Drug Events
As compared with clomiphene, letrozole was associated with higher live-birth and ovulation rates among infertile women
with the polycystic ovary syndrome
N Engl J Med 2014;371:119-29
25. Letrozole
Oral administration
Unifollicular development
Short half life
No depletion of ER
No antiestrogenic effect on cervical mucus and endometrial thickness
Its activity is demonstrated in the ovaries, adipose tissue brain, osteoblasts and breast
Requena A, Herrero J, Landeras J, Navarro E, Neyro J, Salvador C et al. Use of letrozole in assisted reproduction: a
systematic review and meta-analysis. Human Reproduction Update. 2008;14(6):571-582.
26. Letrozole use
Letrozole used in the following
situations
OI in polycystic ovary
syndrome (PCOS)
OI in intrauterine insemination
(IUI)
Ovarian stimulation for
IVF/ICSI
Requena A, Herrero J, Landeras J, Navarro E, Neyro J, Salvador C et al. Use of letrozole in assisted reproduction: a
systematic review and meta-analysis. Human Reproduction Update. 2008;14(6):571-582.
27. Letrozole use
Letrozole in combination
with hMG
reduced duration of
stimulation and total HMG
dose needed for
stimulation
significantly higher
monofollicular
development
The regimen of letrozole + HMG is more effective and safer than CC + HMG or HMG
alone for ovulation induction in cases of CC resistance
Requena A, Herrero J, Landeras J, Navarro E, Neyro J, Salvador C et al. Use of letrozole in assisted reproduction: a
systematic review and meta-analysis. Human Reproduction Update. 2008;14(6):571-582.
28. Therapeutic use of aromatase inhibitor
Breast cancer
(hormone receptor
positive)
Induction of
ovulation (Mitwally
and Casper,2001)
Endometrial
carcinoma &
endometrial stromal
sarcoma
Endometriosis
(Sasson and Taylor
,2009).
Induction of abortion
in combination with
misopristol (Lee et al
2011).
possible role
management of
OHSS
Requena A, Herrero J, Landeras J, Navarro E, Neyro J, Salvador C et al. Use of letrozole in assisted reproduction: a
systematic review and meta-analysis. Human Reproduction Update. 2008;14(6):571-582.
29. Dose regimen of Letrozole
2.5 mg /day from
cycle day 3 to 7
(Mitwally and
Casper,2001)
5 mg/day from
cycle day 3 to 7 (Al-
Fadhli et al ,2006).
20 mg once on
cycle day 3
(Mitwally and
Casper,2005).
2.5 mg/day from
cycle day 1 to 10
(Badawy et al,2009
Requena A, Herrero J, Landeras J, Navarro E, Neyro J, Salvador C et al. Use of letrozole in assisted reproduction: a
systematic review and meta-analysis. Human Reproduction Update. 2008;14(6):571-582.
30. Contraindications of letrozole therapy
Hypersensitivity to Letrozole Pregnancy
Lactation
Severe renal impairment
(Requena et al , 2008).
Requena A, Herrero J, Landeras J, Navarro E, Neyro J, Salvador C et al. Use of letrozole in assisted reproduction: a
systematic review and meta-analysis. Human Reproduction Update. 2008;14(6):571-582.
31. Side effects of Letrozole therapy
Hot flashes (11%), Nausea (7%) Fatigue (5%)
Alopecia and vaginal bleeding
Complications occur more
frequently in breast cancer
patients than in women treated
for ovulation induction due to
differences in the duration of
treatment (Requena et al , 2008).
Requena A, Herrero J, Landeras J, Navarro E, Neyro J, Salvador C et al. Use of letrozole in assisted reproduction: a
systematic review and meta-analysis. Human Reproduction Update. 2008;14(6):571-582.
34. AACE and ESC Recommendations
• Clomiphene citrate (or comparable estrogen modulators such
as Letrozole) as the first-line treatment of anovulatory
infertility in women with PCOS.
Endocrine Society Clinical
Guideline (2013)
• Treatment for women with PCOS and anovulatory infertility
should begin with an oral agent such as clomiphene citrate or
Letrozole, an aromatase inhibitor.
American Association of Clinical
Endocrinologists, American College
of Endocrinology, And Androgen
Excess & PCOS Society (2015)
35. CC should be first-line pharmacotherapy for ovulation induction and letrozole can also be used as first-line
therapy
36. ROLE OF AROMATASE INHIBITORS (LETROZOLE) IN DIFFERENT
TYPES OF INFERTILITY
37. Anovulatory women with PCOS
A pooled analysis of four early randomized
trials has shown a significantly higher
pregnancy rate in women treated with
letrozole or anastrozole compared with
CC.
On the other hand , a large randomized
trial failed to detect any significant
difference in the pregnancy rate between
both management options (Badawy et al..
2007).
Requena A, Herrero J, Landeras J, Navarro E, Neyro J, Salvador C et al. Use of letrozole in assisted reproduction: a
systematic review and meta-analysis. Human Reproduction Update. 2008;14(6):571-582.
38. Unexplained infertility
Five trials compared aromatase inhibitors versus CC and four trials compared aromatase
inhibitors plus gonadotropins versus CC plus gonadotrophins.
Pregnancy rate was comparable between both management options (Polyzos et al .2009).
Requena A, Herrero J, Landeras J, Navarro E, Neyro J, Salvador C et al. Use of letrozole in assisted reproduction: a
systematic review and meta-analysis. Human Reproduction Update. 2008;14(6):571-582.
39. Clomiphene citrate resistant PCOS
LETRIZOLE GONADROPHINS
Requena A, Herrero J, Landeras J, Navarro E, Neyro J, Salvador C et al. Use of letrozole in assisted reproduction: a
systematic review and meta-analysis. Human Reproduction Update. 2008;14(6):571-582.
40. Aromatase inhibitors VERSUS Laparoscopy ovarian drilling
CC resistance
NOW SOLUTION
LETROZOLE
OVARIAN DRILLING IS
OBSOLETE AND NO ROLE
a decade ago only
gonadotrophins
Requena A, Herrero J, Landeras J, Navarro E, Neyro J, Salvador C et al. Use of letrozole in assisted reproduction: a
systematic review and meta-analysis. Human Reproduction Update. 2008;14(6):571-582.
43. Aromatase inhibitors for IVF
In theory, the low estradiol
level in letrozole / FSH
regimen could result in a
favourable endometrium,
and a high implantation
rate.
Furthermore , there should
be lower incidence of
ovarian hyperstimulation
syndrome and premature
luteinization.
Moreover, aromatase
inhibitors increases the
sensitivity of the growing
follicles to FSH stimulation.
Requena A, Herrero J, Landeras J, Navarro E, Neyro J, Salvador C et al. Use of letrozole in assisted reproduction: a
systematic review and meta-analysis. Human Reproduction Update. 2008;14(6):571-582.
47. Use of letrozole for fertility preservation in oncological patients
Supraphysiologic oestradiol
levels resultant of the
ovulation induction with
gonadotropins may promote
the growth of estrogen
sensitive tumours (breast and
endometrial cancer).
The use of aromatase
inhibitors in combination with
gonadotropins for
superovulation to freeze
embryos in patients with
oestrogen sensitive tumours.
The main advantage of this
regimen is that the peak
estradiol levels are closer to
estradiol levels observed in
natural cycles.
Requena A, Herrero J, Landeras J, Navarro E, Neyro J, Salvador C et al. Use of letrozole in assisted reproduction: a
systematic review and meta-analysis. Human Reproduction Update. 2008;14(6):571-582.
49. Summary
Better pregnancy
outcomes and higher
live births compared to
CC in PCOS patients
Effective even in
patients with CC-
resistant PCOS
Reduces Gonadotrophin
dose and superior
alternative to CC in
combined
Gonadotrophin cycles
Monofollicular
development and lower
multiple pregnancies
No anti-estrogenic
effects on endometrium
& cervical mucus
Lower cycle cancellation
and risk of
hyperstimulation is
negligible
Safety established in
clinical studies
Requena A, Herrero J, Landeras J, Navarro E, Neyro J, Salvador C et al. Use of letrozole in assisted reproduction: a
systematic review and meta-analysis. Human Reproduction Update. 2008;14(6):571-582.
Aromatase inhibitors for IVF The recommended regimen in ovarian stimulation for IUI includes the use of letrozole 2.5 mg/day (from Day 3 to Day 7 of the cycle) plus FSH (usually 100 IU/day, although doses can vary depending on the characteristics of the patients) starting on Day 8.