to Evaluate Letrozole as a Modality for Minimal Ovarian Stimulation in ICSI Cycles . Clinical Trial
Official title:
The Role of Aromatase Inhibitor (Letrozole) in Minimal Ovarian Stimulation Protocols in Assisted Reproductive Technology. A Randomized Controlled Trial
| Verified date | July 2016 |
| Source | Assiut University |
| Contact | n/a |
| Is FDA regulated | No |
| Health authority | Egypt: Institutional Review Board |
| Study type | Interventional |
Infertility in not a health problem and that infertile couples are not really ill. However,
this narrow interpretation of the problem is refuted by the world community. The WHO defines
health as a "state of complete physical, mental and social wellbeing and not merely the
absence of disease or infirmity". It has also been argued that overpopulation is the main
problem in the developing countries and that helping infertile couples contradicts the
interests of the countries and the world at large. However, this narrow approach contradicts
human rights in general and reproductive rights in particular.
In 1994, the United Nations International Conference on Population and Development in Cairo
mentioned issues on future actions on 'prevention and appropriate treatment of infertility
where feasible'. However, no guidelines or concrete actions and programmes were given for
developing countries.
Worldwide, more than 80 million couples suffer from infertility; the majority of this
population are residents of developing countries.
In September 2001, a meeting on 'Medical, Ethical and Social Aspects of Assisted
Reproduction' was organized by the WHO. For the first time, major attention was paid to
ongoing developments in assisted reproduction technology together with their social and
ethical implications in developing countries . It was the first time that the WHO
highlighted the issue of assisted reproduction in developing countries.
ART in developed countries is highly expensive one of steps is ovulation induction the most
common protocol for induction is the long gonadotrophin-releasing hormone (GnRH) agonist
pituitary suppression regimen combined with relatively high doses of exogenous
follicle-stimulating hormone (FSH) remains the most frequently used stimulation protocol
which is expensive. in our study we will use a mild ovarian stimulating protocol letrozole
adjuvant to gonadotrophins which is less expensive
The use of aromatase inhibitor have only recently been introduced in infertility treatment,
especially for ovulation induction.
An aromatase inhibitor blocks the conversion of androgens to estrogens in the ovarian
follicles, peripheral tissues, and in the brain. This result in two things: (a) Fall in
circulating and local estrogens and (b) Rise in intraovarian androgens. Fall in estrogen
levels, releases the hypothalamopituitary axis from the negative feedback of estrogens.
Thus, there is a surge in follicle stimulating hormone (FSH) release, which results in
follicular growth. Since, the feedback mechanism is intact; normal follicular growth,
selection of dominant follicle, and atresia of smaller growing follicle occurs; and thereby
facilitating monofollicular growth and ovulation.Another mechanism of action of the
aromatase inhibitors is by the increasing intraovarian androgens. This increases the
follicular sensitivity to FSH. Recent data shows the role of androgens in early follicular
developments. by augmenting FSH receptors and stimulating insulin-like growth factor
(IGF)-I; FSH and IGF-I act synergistically to promote follicular growth. This
pharmacodynamics of letrozole ensures improved endometrial thickness, cervical mucus,
monofollicular, and better folliculogenesis. So , these factors may lead to higher pregnancy
rates and greater likelihood of singleton pregnancy.
Letrozole has been tried for ovarian stimulation for assisted reproduction. With the concept
of mild stimulation in IVF to improve implantation rate, letrozole is a potential agent.
Letrozole has two potential uses in IVF: First, where it is used in the follicular phase
usually with FSH/human menopausal gonadotropin (HMG) for ovulation induction; second, it has
also been used in luteal phase of stimulated IVF cycle and to reduce circulating E2 levels;
thus, potentially reducing ovarian hyperstimulation syndrome (OHSS) risk.
A significant reduction in the total dose of gonadotrophins was found when aromatase
inhibitor was added in controlled ovarian hyperstimulation (COH) cycles.
Some studies evaluated the addition of letrozole in patients with normal ovarian response
undergoing IVF or Intracytoplasmic sperm injection( ICSI). They showed higher implantation
and ongoing pregnancy rates in the letrozole cotreatment group.
| Status | Recruiting |
| Enrollment | 80 |
| Est. completion date | December 2017 |
| Est. primary completion date | October 2016 |
| Accepts healthy volunteers | No |
| Gender | Female |
| Age group | 20 Years to 35 Years |
| Eligibility |
Inclusion Criteria: - Unexplained infertility. - Tubal factor. Included treated hydrosalpinx and pyosalpinx - BMI 18-29. - Antral follicle count (AFC) more than 5 follicles in one ovary. - Normal male semen analysis.Mild male factor: concentrations 10 million - 20 million sperm/ml. Moderate male factor : concentrations 5 million - 10 million sperm/ml. Exclusion Criteria: - Patients with Endometriosis. - Azoospermic male. - BMI more than 29. |
Allocation: Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment
| Country | Name | City | State |
|---|---|---|---|
| Egypt | of Medicine | Assiut |
| Lead Sponsor | Collaborator |
|---|---|
| Assiut University |
Egypt,
| Type | Measure | Description | Time frame | Safety issue |
|---|---|---|---|---|
| Primary | total dose of FSH administered | 2 years | Yes | |
| Primary | The number of mature follicles developed | 2 years | Yes | |
| Primary | the levels of terminal E2 pg/mL | 2 years | Yes | |
| Primary | number of oocytes retrieved | 2 years | Yes | |
| Primary | endometrial thickness/mm | 2 years | Yes | |
| Primary | number transferable embryos | 2 years | Yes | |
| Secondary | Number of patient who get pregnant | 2 years | Yes |