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Reassessing the impact of letrozole co-administration in controlled ovarian hyperstimulation: findings from a single-center repeated measures study

  • Assisted Reproduction Technologies
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Abstract

Purpose

To explore whether letrozole improved outcomes in subsequent controlled ovarian hyperstimulation (COH) cycles.

Methods

This was a retrospective repeated measures cohort study examining COH cycles. Patients were included if they underwent two cycles for unexplained infertility, male factor infertility, or planned oocyte/embryo cryopreservation. The first cycles for all patients implemented a non-letrozole, conventional gonadotropin protocol. Second cycles for the study group included letrozole (2.5–7.5 mg for 5 days) with no medication change to second cycles amongst controls.

Our primary objective was to compare oocyte yield. Cohorts were then subdivided by pursuit of oocyte (OC) or embryo (IVF) cryopreservation. Secondary outcome amongst the OC subgroup was oocyte maturation index (metaphase II (MII)/total oocytes). Secondary outcomes amongst the IVF subgroup were normal fertilization rate (2-pronuclear zygotes (2PN)/oocytes exposed to sperm), blastocyst formation rate (blastocysts/2PNs), and embryo ploidy (%euploid and aneuploid).

Results

Fifty-four cycles (n = 27) were included in letrozole and 108 cycles (n = 54) were included in control. Oocyte yield was higher in second cycles (p < 0.008) in the letrozole group but similar in second cycles (p = 0.26) amongst controls. Addition of letrozole did not impact MII index (p = 0.90); however, MII index improved in second cycles amongst controls (p < 0.001). Both groups had similar rates of normal fertilization (letrozole: p = 0.52; control: p = 0.61), blast formation (letrozole: p = 0.61; control: p = 0.84), euploid (letrozole: p = 0.29; control: p = 0.47), and aneuploid embryos (letrozole: p = 0.17; control: p = 0.78) between cycles.

Conclusions

Despite improved oocyte yield, letrozole did not yield any difference in oocyte maturation or embryo outcomes.

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Acknowledgements

The authors would like to acknowledge the hard work and mentorship of the clinical and embryology team at the NYU Langone Fertility Center, to make this research possible for trainees.

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Authors and Affiliations

  1. New York University Langone Fertility Center, 159 E 53rd Street, Floor 3, New York, NY, 10022, USA

    Nirali S. Jain, Frederick Licciardi & Jennifer K. Blakemore

  2. Department of Obstetrics and Gynecology, New York University Grossman School of Medicine, New York, NY, USA

    Shilpa Kalluru & David H. McCulloh

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  1. Nirali S. Jain
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  2. Frederick Licciardi
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Correspondence to Nirali S. Jain.

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Jain, N.S., Licciardi, F., Kalluru, S. et al. Reassessing the impact of letrozole co-administration in controlled ovarian hyperstimulation: findings from a single-center repeated measures study. J Assist Reprod Genet 41, 979–987 (2024). https://doi.org/10.1007/s10815-024-03067-z

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