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Udgivet

Co-treatment with letrozole during ovarian stimulation for IVF/ICSI: a systematic review and meta-analysis

Publikation: Bidrag til tidsskriftReviewForskningpeer review

DOI

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Vis graf over relationer

Letrozole reduces serum oestradiol by inhibiting the aromatase enzyme and has growing clinical indications in fertility. The available evidence of letrozole's role in ovarian stimulation for IVF and intracytoplasmic sperm injection (ICSI) and clinical outcomes was assessed. Medline, Cochrane, and ClinicalTrials.gov databases were systematically searched up until August 2021, including 31 studies (n = 16 randomized controlled trials [RCTs]; n = 15 observational studies). Live birth rate (LBR) in poor responders significantly increased by 7% (95% CI, 1% to 13%, P = 0.03) with letrozole co-treatment. Concomitantly, the gonadotrophin consumption was significantly reduced, without decreasing the number of retrieved oocytes. In normal responders, number of oocytes increased with 1.8 oocytes (95% CI 0.35 to 3.27, P = 0.01) with letrozole co-treatment. No significant effect on LBR, clinical pregnancy rate (CPR), or ovarian hyperstimulation syndrome rate was demonstrated. Only two studies reported on high responders and revealed no effect on LBR or CPR. Overall, the endometrium thickness was slightly affected, where as the, miscarriage rate and cancellation rate were unaffected by letrozole co-treatment. None of the included studies reported on neonatal outcomes. The quality of evidence was high or moderate in the RCTs and low in the observational studies. In conclusion, poor responders may benefit from co-treatment with letrozole during ovarian stimulation for IVF, whereas letrozole for normal and high responders requires further investigation with larger, high-quality studies.

OriginalsprogEngelsk
TidsskriftReproductive BioMedicine Online
Vol/bind44
Sider (fra-til)717-736
Antal sider20
ISSN1472-6483
DOI
StatusUdgivet - apr. 2022

Bibliografisk note

Funding Information:
We thank the corresponding authors who provided missing data for the analyses, and information specialist Anders Larsen, UCSF, Medical Research Centre, University Hospital, Copenhagen, for his expertise in developing the search strategy. We also acknowledge constructive statistical guidance from Associate Professor Julie Lyng Forman, Section on Biostatistics, Copenhagen University. Templates, collection forms, and extracted data used in the analyses can be requested through the corresponding author.

Publisher Copyright:
© 2021 Reproductive Healthcare Ltd.

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