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Nguyen TT, Doan HT, Quan LH, Lam NM. Effect of letrozole for ovulation induction combined with intrauterine insemination on women with polycystic ovary syndrome. Gynecol Endocrinol 2020; 36:860-863. [PMID: 32241195 DOI: 10.1080/09513590.2020.1744556] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 03/12/2020] [Accepted: 03/16/2020] [Indexed: 10/24/2022] Open
Abstract
Objectives: To evaluate the efficacy and safety of letrozole on ovulation induction and pregnancy in infertility patients with polycystic ovary syndrome (PCOS). In addition, the insulin resistance was analyzed in these patients.Subjects and methods: Progressive description study with comparison. The study included 80 infertility women divided into two groups: 40 women with PCOS (the study group) and 40 women without PCOS (the control group). The both used letrozole for ovulation induction from cycle day 2.Results: No differences in the dominant follicle between the study group and the control group (1.16 ± 0.37 follicles and 1.30 ± 0.46 follicles, respectively). The clinical pregnancy rate was 22.5% of the both groups. The average insulin of the study group (10.85 ± 5.84 µUI/ml) and their average HOMA-IR (2.42 ± 1.34) were higher than the control group (7.44 ± 2.84 µUI/ml and 1.57 ± 0.68), p < .05. The QUICKI of the study group (0.35 ± 0.29) was lower than the control group (0.36 ± 0.25), p < .05.Conclusion: Letrozole is used to stimulate the ovaries of the infertile women with PCOS combined with intrauterine insemination is the effective treatment. These patients had the high risk of insulin resistance.
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Affiliation(s)
- Tung Thanh Nguyen
- IVF Department, Military Institute of Clinical Embryology and Histology, Military Medical University, Ha Noi, Vietnam
| | - Hang Thi Doan
- IVF Department, Military Institute of Clinical Embryology and Histology, Military Medical University, Ha Noi, Vietnam
| | - Lam Hoang Quan
- Military Institute of Clinical Embryology and Histology, Military Medical University, Ha Noi, Vietnam
| | - Ngoc Mai Lam
- Assisted Reproductive Technique Unit, Phu Tho Obstetrics and Pediatrics center, Viet Tri, Vietnam
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Ferreiro E, de Uralde BL, Abreu R, García-Velasco JA, Muñoz E. Aromatase Inhibitors for Ovarian Stimulation in Patients with Breast Cancer. Curr Drug Targets 2020; 21:910-921. [PMID: 32077823 DOI: 10.2174/1389450121666200220124607] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 02/07/2020] [Accepted: 02/10/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Breast cancer is the most common malignancy diagnosed in women, and its treatment has a high probability of loss of fertility. Oocyte vitrification is the most commonly used technique to preserve fertility before starting oncological treatment. Aromatase inhibitors induce hypoestrogenemia while promoting the release of gonadotropins and constitute an alternative drug for ovarian stimulation in patients with breast cancer. OBJECTIVE In this mini-review, we update and describe the current status of aromatase inhibitor use in controlled ovarian stimulation for oocyte vitrification in patients with breast cancer. RESULTS Aromatase inhibitors are commonly used in combination with gonadotropins for ovarian stimulation in patients with breast cancer who preserve their fertility through oocyte vitrification. They achieve similar ovarian responses as conventional ovarian stimulation protocols in regards to the number of oocytes, and no additional complications after their use have been reported. Furthermore, aromatase inhibitors seem to be safe not only for offspring, as no more congenital defects occur in newborns from pregnancies achieved after their use, but also for the patients, as no more malignancy recurrence or increased mortality was found in cohort studies. CONCLUSION Aromatase inhibitors are elective drugs for ovarian stimulation in patients with breast cancer who decide to preserve their fertility through oocyte vitrification.
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Affiliation(s)
- Esteban Ferreiro
- IVIRMA Vigo, Plaza Francisco Fernandez del Riego, 7 36203, Vigo Pontevedra, Spain
| | | | - Rita Abreu
- IVIRMA Vigo, Plaza Francisco Fernandez del Riego, 7 36203, Vigo Pontevedra, Spain
| | | | - Elkin Muñoz
- IVIRMA Vigo, Plaza Francisco Fernandez del Riego, 7 36203, Vigo Pontevedra, Spain
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Aromatase Inhibition Ameliorates Decreased LH Output Found in Obese Women. Reprod Sci 2020; 27:1018-1023. [PMID: 32046430 PMCID: PMC7142050 DOI: 10.1007/s43032-019-00105-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 07/23/2019] [Indexed: 10/31/2022]
Abstract
In obese ovulatory women, serum luteinizing Hormone (LH) and follicle stimulating hormone (FSH) are lowered compared with normal weight women. This relative hypogonadotropic hypogonadism represents a potential etiology for overall decreased fertility in obesity. The objective was to determine if administration of an aromatase inhibitor (AI) to ovulating obese women would normalize LH and FSH by interrupting estradiol negative feedback. Letrozole (2.5-5 mg) was given daily to 22 women, 12 obese and 10 normal weight, for 7 days. On the last day of administration, 8 h of blood sampling was done every 10 min before and after a bolus of GnRH at 4 h. We obtained data from 21 ovulatory women (10 normal weight and 11 obese) who had undergone a similar protocol of frequent blood sampling but no aromatase inhibitors (AI) treatment. Serum LH and FSH levels and pulse characteristics were measured. Treatment with AI only significantly affected obese women. Further, in women with obesity, LH secretion, prior to the GnRH bolus, was significantly higher in AI treated compared with non-treated (p = 0.011). AI treatment doubled LH pulse amplitude in obese women (p = 0.004). In response to aromatase inhibition, LH secretion in ovulatory women with obesity is increased and similar to levels found in untreated normal weight women. The increase in LH pulse amplitude indicates that the AI effect is mediated at the level of the pituitary. Our results suggest that the hypogonadotropic phenotype of simple obesity is subject to modulation by interruption of estradiol negative feedback.
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Rosenfeld CS, Shay DA, Vieira-Potter VJ. Cognitive Effects of Aromatase and Possible Role in Memory Disorders. Front Endocrinol (Lausanne) 2018; 9:610. [PMID: 30386297 PMCID: PMC6199361 DOI: 10.3389/fendo.2018.00610] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 09/26/2018] [Indexed: 12/14/2022] Open
Abstract
Diverse cognitive functions in many vertebrate species are influenced by local conversion of androgens to 17β-estradiol (E2) by aromatase. This enzyme is highly expressed in various brain regions across species, with some inter-species variation in terms of regional brain expression. Since women with breast cancer and men and women with other disorders are often treated with aromatase inhibitors (AI), these populations might be especially vulnerable to cognitive deficits due to low neuroE2 synthesis, i.e., synthesis of E2 directly within the brain. Animal models have been useful in deciphering aromatase effects on cognitive functions. Consequences of AI administration at various life cycle stages have been assessed on auditory, song processing, and spatial memory in birds and various aspects of cognition in rodent models. Additionally, cognitive deficits have been described in aromatase knockout (ArKO) mice that systemically lack this gene throughout their lifespan. This review will consider evidence to date that AI treatment in male and female rodent models, birds, and humans results in cognitive impairments. How brain aromatase regulates cognitive function throughout the lifespan, and gaps in current knowledge will be considered, along with future directions to better define how aromatase might guide learning and memory from early development through the geriatric period. Better understanding the importance of E2 synthesis on neurobehavioral responses at various ages will likely aid in the discovery of therapeutic strategies to prevent potential cognitive deficits, including Alzheimer's Disease, in individuals treated with AI or those possessing CYP19 gene polymorphisms, as well as cognitive effects of normal aging that may be related to changes in brain aromatase activity.
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Affiliation(s)
- Cheryl S. Rosenfeld
- Bond Life Sciences Center, University of Missouri, Columbia, MO, United States
- Thompson Center for Autism and Neurobehavioral Disorders, University of Missouri, Columbia, MO, United States
- Biomedical Sciences, University of Missouri, Columbia, MO, United States
- *Correspondence: Cheryl S. Rosenfeld
| | - Dusti A. Shay
- Nutrition and Exercise Physiology, University of Missouri, Columbia, MO, United States
| | - Victoria J. Vieira-Potter
- Nutrition and Exercise Physiology, University of Missouri, Columbia, MO, United States
- Victoria J. Vieira-Potter
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Haas J, Bassil R, Meriano J, Samara N, Barzilay E, Gonen N, Casper RF. Does daily co-administration of letrozole and gonadotropins during ovarian stimulation improve IVF outcome? Reprod Biol Endocrinol 2017; 15:70. [PMID: 28854933 PMCID: PMC5577762 DOI: 10.1186/s12958-017-0288-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 08/24/2017] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND For the last year we have been treating normal responders with gonadotropins and letrozole during the whole stimulation in order to improve response to FSH by increasing the intrafollicular androgen concentration, and to reduce circulating estrogen concentrations. The aim of this study was to compare the IVF outcome of normal responders treated with letrozole and gonadotropins during ovarian stimulation with patients treated with gonadotropins only. METHODS A single centre retrospective cohort study of 174 patients (87 in each group). RESULTS The age of the patients was comparable between the groups. Estradiol levels were significantly higher in the control group (6760 pmol/L vs. 2420 pmol/L respectively, p < 0.01), and the number of follicles ≥15 mm at the trigger day was significantly lower in the control group (7.9 vs. 10, p = 0.02). The number of retrieved oocytes (10 vs. 14.5, p < 0.01), MII oocytes (7.9 vs. 11.2, p < 0.01) and blastocysts (2.7 vs. 4.0, p = 0.02) was significantly higher in the study group. We found no significant differences in the cumulative pregnancy outcome between the two groups (65.2% vs 58.3% p = NS). CONCLUSIONS We conclude that co-treatment with letrozole improves the IVF outcome in normal responders in terms of increased number of blastocysts obtained without increasing the pregnancy rate or the risk of OHSS.
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Affiliation(s)
- Jigal Haas
- 0000 0001 2157 2938grid.17063.33Division of Reproductive Sciences, University of Toronto, Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON Canada
- TRIO fertility partners, 655 Bay St, Toronto, ON M5G 2K4 Canada
- 0000 0004 1937 0546grid.12136.37Chaim Sheba medical Center, Tel Hashomer, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rawad Bassil
- 0000 0001 2157 2938grid.17063.33Division of Reproductive Sciences, University of Toronto, Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON Canada
- TRIO fertility partners, 655 Bay St, Toronto, ON M5G 2K4 Canada
| | - Jim Meriano
- 0000 0001 2157 2938grid.17063.33Division of Reproductive Sciences, University of Toronto, Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON Canada
- TRIO fertility partners, 655 Bay St, Toronto, ON M5G 2K4 Canada
| | - Nivin Samara
- 0000 0001 2157 2938grid.17063.33Division of Reproductive Sciences, University of Toronto, Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON Canada
- TRIO fertility partners, 655 Bay St, Toronto, ON M5G 2K4 Canada
| | - Eran Barzilay
- 0000 0001 2157 2938grid.17063.33Division of Reproductive Sciences, University of Toronto, Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON Canada
- TRIO fertility partners, 655 Bay St, Toronto, ON M5G 2K4 Canada
- 0000 0004 1937 0546grid.12136.37Chaim Sheba medical Center, Tel Hashomer, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Noa Gonen
- 0000 0001 2157 2938grid.17063.33Division of Reproductive Sciences, University of Toronto, Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON Canada
- TRIO fertility partners, 655 Bay St, Toronto, ON M5G 2K4 Canada
| | - Robert F. Casper
- 0000 0001 2157 2938grid.17063.33Division of Reproductive Sciences, University of Toronto, Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON Canada
- TRIO fertility partners, 655 Bay St, Toronto, ON M5G 2K4 Canada
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Comparative effectiveness of 9 ovulation-induction therapies in patients with clomiphene citrate-resistant polycystic ovary syndrome: a network meta-analysis. Sci Rep 2017. [PMID: 28630466 PMCID: PMC5476620 DOI: 10.1038/s41598-017-03803-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
The comparative efficacies of ovulation-induction treatments in patients with clomiphene citrate-resistant (CCR) polycystic ovary syndrome (PCOS) are not well known. Therefore, we conducted a network meta-analysis to rank the reproductive efficacies of these treatments. We ultimately included 26 randomized clinical trials with 2722 participants and 9 types of therapies: clomiphene citrate (CC), metformin, letrozole, follicle stimulating hormone (FSH), human menopausal gonadotropin (hMG), unilateral laparoscopic ovarian drilling (ULOD), bilateral laparoscopic ovarian drilling (BLOD), the combination of metformin with letrozole (metformin+letrozole), and the combination of metformin with CC (metformin+CC). The network meta-analysis demonstrates that hMG therapy result in higher pregnancy rates than BLOD, ULOD and CC therapies. Pregnancy, live birth and ovulation rates are significantly higher in metformin+letrozole and FSH groups than CC group. The abortion rate in the metformin+letrozole group is significantly lower than that in the metformin+CC group. Ranking probabilities show that, apart from gonadotropin (FSH and hMG), metformin+letrozole is also potentially more effective in improving reproductive outcomes than other therapies. In conclusion, owing to the low quality of evidence and the wide confidence intervals, no recommendation could be made for the treatment of ovulation-induction in patients with CCR PCOS.
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Ma X, He J, Huang Y, Xiao Y, Wang Q, Li H. Investigation and comparison of the binding between tolvaptan and pepsin and trypsin: Multi-spectroscopic approaches and molecular docking. J Mol Recognit 2016; 30. [DOI: 10.1002/jmr.2598] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 11/04/2016] [Accepted: 11/06/2016] [Indexed: 12/19/2022]
Affiliation(s)
- Xiangling Ma
- College of Chemical Engineering; Sichuan University; Chengdu Sichuan China
| | - Jiawei He
- College of Chemical Engineering; Sichuan University; Chengdu Sichuan China
| | - Yanmei Huang
- College of Chemical Engineering; Sichuan University; Chengdu Sichuan China
| | - Ying Xiao
- College of Chemical Engineering; Sichuan University; Chengdu Sichuan China
| | - Qing Wang
- College of Chemical Engineering; Sichuan University; Chengdu Sichuan China
| | - Hui Li
- College of Chemical Engineering; Sichuan University; Chengdu Sichuan China
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Pereira N, Hancock K, Cordeiro CN, Lekovich JP, Schattman GL, Rosenwaks Z. Comparison of ovarian stimulation response in patients with breast cancer undergoing ovarian stimulation with letrozole and gonadotropins to patients undergoing ovarian stimulation with gonadotropins alone for elective cryopreservation of oocytes†. Gynecol Endocrinol 2016; 32:823-826. [PMID: 27114051 DOI: 10.1080/09513590.2016.1177013] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
The primary objective of this study is to compare the oocyte yield in breast cancer patients undergoing controlled ovarian stimulation (COS) using letrozole and gonadotropins with patients undergoing COS with standard gonadotropins for elective cryopreservation of oocytes. Odds ratios (OR) for the number of mature oocytes were estimated. Pregnancy outcomes for breast cancer patients undergoing frozen-thawed 2-PN embryo transfers (FETs) after oncologic treatment were also noted. 220 and 451 cycles were identified in the breast cancer and the elective cryopreservation groups, respectively. Patients in the former group had lower peak estradiol levels [464.5 (315.5-673.8) pg/mL] compared to the latter [1696 (1058-2393) pg/mL; p < 0.01]. More oocytes were retrieved in the breast cancer group (12.3 ± 3.99) compared to the elective cryopreservation group (10.9 ± 3.86; p < 0.01). The odds for mature oocytes with letrozole and gonadotropins was 2.71 (95% CI 1.29-5.72; p = 0.01). Fifty-six FETs occurred in the breast cancer group. The clinical pregnancy and live birth rates per FET cycle were 39.7%, and 32.3%, respectively. Our findings suggest that COS with letrozole and gonadotropins yield more mature oocytes at lower estradiol levels compared to COS with gonadotropins alone. Breast cancer patients undergoing FET after oncologic treatment have live birth rates comparable to age-matched counterparts.
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Affiliation(s)
- Nigel Pereira
- a Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical Center , New York , NY , USA
| | - Kolbe Hancock
- a Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical Center , New York , NY , USA
| | - Christina N Cordeiro
- a Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical Center , New York , NY , USA
| | - Jovana P Lekovich
- a Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical Center , New York , NY , USA
| | - Glenn L Schattman
- a Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical Center , New York , NY , USA
| | - Zev Rosenwaks
- a Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical Center , New York , NY , USA
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Huang YM, Zheng SJ, Yan J, Yang HQ, Wu D, Wang Q, Li H. Investigation on the interaction of letrozole with herring sperm DNA through spectroscopic and modeling methods. LUMINESCENCE 2015; 31:1077-84. [DOI: 10.1002/bio.3074] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 11/11/2015] [Accepted: 11/12/2015] [Indexed: 01/18/2023]
Affiliation(s)
- Yan-Mei Huang
- College of Chemical Engineering; Sichuan University; Chengdu People's Republic of China
| | - Shou-Jun Zheng
- College of Chemical Engineering; Sichuan University; Chengdu People's Republic of China
| | - Jin Yan
- College of Chemical Engineering; Sichuan University; Chengdu People's Republic of China
| | - Hong-Qin Yang
- College of Chemical Engineering; Sichuan University; Chengdu People's Republic of China
| | - Di Wu
- College of Chemical Engineering; Sichuan University; Chengdu People's Republic of China
| | - Qing Wang
- College of Chemical Engineering; Sichuan University; Chengdu People's Republic of China
| | - Hui Li
- College of Chemical Engineering; Sichuan University; Chengdu People's Republic of China
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Garcia Velasco JA, Seli E. IVF: a short but exciting story. Curr Opin Obstet Gynecol 2015; 27:165-6. [PMID: 25919232 DOI: 10.1097/gco.0000000000000178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Juan Antonio Garcia Velasco
- aIVI-Madrid, and Rey Juan Carlos University, Madrid, Spain bDepartment of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut, USA
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