Combined down-regulation by aromatase inhibitor and GnRH-agonist in IVF patients with endometriomas-A pilot study.

Abstract

OBJECTIVE:

The key enzyme in the biosynthesis of estradiol, aromatase, has been demonstrated within endometriosis. Combined administration of aromatase inhibitor and GnRH-agonist may efficiently suppress estrogen biosynthesis through a combined pituitary, ovarian, peripheral and "in situ" action. The aim of this study was to test the concept of combined down-regulation prior to IVF in patients with endometriomas.

STUDY DESIGN:

Prospective pilot study in a university-based tertiary fertility clinic including 20 infertile patients with endometriomas undergoing IVF/ICSI. The patients received goserelin 3.6mg sc on treatment Days 1, 28 and 56, and one daily tablet of anastrozole 1mg from Day 1 to Day 69. Controlled ovarian stimulation was initiated from Day 70. Outcome measures were change in endometriomal volume and serum CA125 during down-regulation, standard IVF parameters including pregnancy and delivery rate, and endocrine response. The paired T test and Wilcoxon Signed Rank test were used to analyse paired differences.

RESULTS:

During the combined down-regulation, the endometriomal volume and the serum CA125 level decreased by 29% (3-39%) and 61% (21-74%), respectively (median (95%CI), P=0.007 and P=0.001). In the IVF/ICSI cycle, the number of oocytes retrieved was 7.5 (6.0-10.0) and the fertilization rate was 0.78 (0.38-1.0). Nine patients (45%) conceived, five (25%) had a clinical pregnancy, and three (15%) delivered healthy children (two singletons and one twin).

CONCLUSIONS:

Prolonged combined anastrozole and goserelin down-regulation significantly reduces endometriomal volume and serum CA125, and is compatible with IVF pregnancy and delivery. However, a high pregnancy loss was noted.

• Authors: Kristine Lossl, Anne Loft, Nina L C Freiesleben, Susanne Bangsbøll, Claus Yding Andersen, Anette T Pedersen, Dorthe Hartwell, Anders Nyboe Andersen
• Journal: European journal of obstetrics, gynecology, and reproductive biology (Eur J Obstet Gynecol Reprod Biol) Vol. 144 Issue 1 Pg. 48-53 (May 2009) ISSN: 1872-7654 [Electronic] Ireland
• PMID: 19261371 (Publication Type: Clinical Trial, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Aromatase Inhibitors
• CA-125 Antigen
• Estrogens
• Nitriles
• Triazoles
• Goserelin
• Anastrozole
• Gonadotropin-Releasing Hormone

Topics

• Adult
• Anastrozole
• Aromatase Inhibitors (adverse effects, pharmacology, therapeutic use)
• CA-125 Antigen (blood)
• Down-Regulation (drug effects)
• Drug Therapy, Combination
• Endometriosis (blood, drug therapy, pathology)
• Estrogens (metabolism)
• Female
• Fertilization in Vitro
• Gonadotropin-Releasing Hormone (agonists)
• Goserelin (pharmacology, therapeutic use)
• Humans
• Nitriles (adverse effects, pharmacology, therapeutic use)
• Pilot Projects
• Pregnancy
• Pregnancy Outcome
• Prospective Studies
• Triazoles (adverse effects, pharmacology, therapeutic use)
• Uterine Diseases (blood, drug therapy, pathology)