Effects of Aromatase Inhibitor on Reproductive Hormone Profiles and Ovulation Induction

Kim, Sook Hyun; Kim, Jeong Ah; Park, Joon Cheol; Bae, Jin Gon; Shin, So Jin; Kwon, Sang Hoon; Cho, Chi Heum; Yoon, Sung Do; Cha, Soon Do; Kim, Jong In; Rhee, Jeong Ho

Abstract

OBJECTIVE
To investigate the effects of aromatase inhibitor on reproductive hormone profiles and evaluate it's ovulation inducing capability in anovulatory infertile women.
METHODS
We quantified the blood levels of reproductive hormones from 30 healthy normal cycling women in natural cycle (control) and letrozole medicated cycle (study). LH, FSH, estradiol, testosterone, DHEA-S were quantified on third, 11th, 21th day in both cycles, and on 21th day, progesterone was added. Sixth anovulatory infertile women received either letrozole or clomiphene citrate for ovulation induction (n=30 in each groups). We compared the clinical parameters such as ovulation rate, pregnancy rate, the day of LH surge, number of follicles and endometrial thickness, cervical mucus amount, spinnbarkeit, mean diameter of follicles on the day of LH surge.
RESULTS
Letrozole had no effect on the LH, FSH, estradiol, DHEA-S secretion but there were significant increase in testosterone level on day 11 and progesterone level on day 21 in letrozole medicated cycle compared than control cycle (0.40+/-0.16 vs 0.28+/-0.11 ng/ml, p=0.002, 18.18+/-13.07 vs 8.38+/-7.64 ng/ml, p=0.001, respectively). In comparison between letrozole and clomiphene groups, there were no significant difference in ovulation rate, pregnancy rate, number of mature follicle, mean diameter of follicles, but showed earlier LH surge, thicker endometrium, more cervical mucus, and higher spinnbarkeit in letrozole group (12.12+/-2.46 vs 14.52+/-3.18 days, p=0.006, 10.48+/-1.23 vs 8.52+/-0.93 mm, p=0.000, 2.04+/-0.61 vs 1.57+/-0.59, p=0.012, 6.00+/-1.12 vs 4.95+/-1.61 cm, p=0.003, respectively).
CONCLUSION
Letrozole may augment folliculogenesis and improve the endometrial condition for implantation in normal cycling women. Ovulation efficacy of letrozole in anovulatory women was comparable to clomiphene citrate and letrozole may be more physiological in ovulation induction.