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Combined down-regulation by aromatase inhibitor and GnRH-agonist in IVF patients with endometriomas-A pilot study
Kristine Lossl1, Anne Loft, Nina L C Freiesleben
1Copenhagen University Hospital, Rigshospitalet, Blegdamsvej, Denmark. kristineloessl@hotmail.com
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.
Insights
Combined down-regulation with anastrozole and goserelin effectively reduced endometrioma volume and CA125 levels in infertile patients. This approach is compatible with in vitro fertilization (IVF) pregnancy and delivery, though pregnancy loss was observed.
Area of Science:
- Reproductive Endocrinology
- Gynecologic Oncology
- In Vitro Fertilization
Background:
- Aromatase is crucial for estradiol biosynthesis and is present in endometriosis.
- Combined therapy using aromatase inhibitors and GnRH agonists can suppress estrogen production via multiple pathways.
- Endometriomas are associated with infertility and elevated CA125 levels.
Purpose of the Study:
- To evaluate the efficacy of combined down-regulation using anastrozole and goserelin before in vitro fertilization (IVF) in patients with endometriomas.
- To assess the impact on endometrioma volume and serum CA125 levels.
- To determine the compatibility with IVF outcomes.
Main Methods:
- Prospective pilot study involving 20 infertile patients with endometriomas undergoing IVF/ICSI.
- Patients received goserelin (GnRH agonist) and anastrozole (aromatase inhibitor) for 69 days.
- Ovarian stimulation for IVF/ICSI commenced on Day 70, with outcomes including endometrioma volume, CA125, IVF parameters, and pregnancy rates analyzed.
Main Results:
- A significant reduction in endometrioma volume (29%) and serum CA125 (61%) was observed during the down-regulation period.
- The IVF/ICSI cycle yielded 7.5 oocytes retrieved with a 0.78 fertilization rate.
- Pregnancy and delivery rates were 45% and 15%, respectively, with a notable rate of pregnancy loss.
Conclusions:
- Prolonged combined anastrozole and goserelin down-regulation effectively reduces endometrioma size and serum CA125.
- This regimen is compatible with successful IVF pregnancies and deliveries.
- A high rate of pregnancy loss warrants further investigation and consideration.
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