Comparison of an estradiol patch and GnRH-antagonist protocol with a letrozole/antagonist protocol for patients without oocyte development, fertilization and/or embryo development in previous IVF cycles

Abstract

Comparison of an estradiol patch and GnRH-antagonist protocol with a letrozole/antagonist protocol for patients without oocyte development, fertilization and/or embryo development in previous IVF cycles Aybike Pekin1 , Ayşe Gül Kebapçılar2 , Ersin Çintesun2 , Setenay Arzu Yılmaz2 , Özlem Seçilmiş Kerimoğlu2, * 1Department of Obstetrics and Gynecology, Mersin Training and Research Hospital, 33240 Toroslar, Mersin, Turkey 2Department of Obstetrics and Gynecology, Faculty of Medicine, Selcuk University, 42100 Selçuklu, Konya, Turkey *Correspondence: ozlemsecilmis@selcuk.edu.tr (Özlem Seçilmiş Kerimoğlu) DOI:10.31083/j.ceog4804146 This is an open access article under the CC BY 4.0 license (https://creativecommons.org/licenses/by/4.0/). Submitted: 27 November 2020 Revised: 19 March 2021 Accepted: 31 March 2021 Published: 15 August 2021 Background: Diminished ovarian reserve (DOR) is a challenge for clinicians in IVF cycles and several treatment modalities have been suggested to improve outcomes. The aim of this study was to compare live birth rates following ovarian stimulation using a luteal phase estradiol (E2)/gonadotropin releasing hormone (GnRH) antagonist protocol (LPG group) with a letrozole/antagonist (LA group) protocol in patients with DOR. Methods: A total of 51 women with DOR, previously canceled IVF cycles and aged 40 years or less were investigated. In the LPG group (n = 26), a transdermal E2 patch was applied every other day starting 10 days after the luteinizing hormone (LH) surge. At day 11 after the LH surge, GnRH antagonists were administered for three consecutive days. In the LA group (n = 25), letrozole (5 mg/day) treatment was begun on the second day of menstruation and administered for 5 consecutive days. In both groups, gonadotropins were initiated on the second day of menstruation. Results for the two groups were compared using chi-square and Student's t-test, as appropriate. Results: Although the initial and total gonadotropin doses were significantly higher in the LPG group, the peak E2 levels, number of oocytes and fertilization rates and cancellation rates were similar. Trends toward improved live birth rates per transfer (23% vs. 11%) and per cycle (11.5% vs. 4%) were seen in the LPG group compared to the LA group, although the differences were not statistically significant. Discussion: DOR patients with previously canceled IVF cycles may be treated with either the LPG or LA protocols. Keywords Diminished ovarian reserve; Estradiol patch; Letrozole; GnRH-antagonist protocol