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

Kristine Lossl; Anne Loft; Nina L C Freiesleben; Susanne Bangsbøll; Claus Yding Andersen; Anette T Pedersen; Dorthe Hartwell; Anders Nyboe Andersen; Kristine Løssl; Anne Loft; Nina L C Freiesleben; Susanne Bangsbøll; Claus Yding Andersen; Anette T Pedersen; Dorthe Hartwell; Anders Nyboe Andersen

doi:10.1016/j.ejogrb.2009.02.001

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

Kristine Lossl, Anne Loft, Nina L C Freiesleben, Susanne Bangsbøll, Claus Yding Andersen, Anette T Pedersen, Dorthe Hartwell, Anders Nyboe Andersen, Kristine Løssl, Anne Loft, Nina L C Freiesleben, Susanne Bangsbøll, Claus Yding Andersen, Anette T Pedersen, Dorthe Hartwell, Anders Nyboe Andersen

30 Citations (Scopus)

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.

Original language	English
Journal	European Journal of Obstetrics & Gynecology and Reproductive Biology
Volume	144
Issue number	1
Pages (from-to)	48-53
Number of pages	6
ISSN	0301-2115
DOIs	https://doi.org/10.1016/j.ejogrb.2009.02.001 https://doi.org/10.1016/j.ejogrb.2009.02.001
Publication status	Published - 1 May 2009

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Lossl, K., Loft, A., Freiesleben, N. L. C., Bangsbøll, S., Andersen, C. Y., Pedersen, A. T., Hartwell, D., Andersen, A. N., Løssl, K., Loft, A., Freiesleben, N. L. C., Bangsbøll, S., Andersen, C. Y., Pedersen, A. T., Hartwell, D., & Andersen, A. N. (2009). Combined down-regulation by aromatase inhibitor and GnRH-agonist in IVF patients with endometriomas-A pilot study. European Journal of Obstetrics & Gynecology and Reproductive Biology, 144(1), 48-53. https://doi.org/10.1016/j.ejogrb.2009.02.001, https://doi.org/10.1016/j.ejogrb.2009.02.001

Combined down-regulation by aromatase inhibitor and GnRH-agonist in IVF patients with endometriomas-A pilot study. / Lossl, Kristine; Loft, Anne; Freiesleben, Nina L C et al.

In: European Journal of Obstetrics & Gynecology and Reproductive Biology, Vol. 144, No. 1, 01.05.2009, p. 48-53.

Research output: Contribution to journal › Journal article › Research › peer-review

Lossl, K, Loft, A, Freiesleben, NLC, Bangsbøll, S, Andersen, CY , Pedersen, AT, Hartwell, D, Andersen, AN, Løssl, K, Loft, A, Freiesleben, NLC, Bangsbøll, S, Andersen, CY , Pedersen, AT, Hartwell, D & Andersen, AN 2009, 'Combined down-regulation by aromatase inhibitor and GnRH-agonist in IVF patients with endometriomas-A pilot study', European Journal of Obstetrics & Gynecology and Reproductive Biology, vol. 144, no. 1, pp. 48-53. https://doi.org/10.1016/j.ejogrb.2009.02.001, https://doi.org/10.1016/j.ejogrb.2009.02.001

Lossl K, Loft A, Freiesleben NLC, Bangsbøll S, Andersen CY , Pedersen AT et al. Combined down-regulation by aromatase inhibitor and GnRH-agonist in IVF patients with endometriomas-A pilot study. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2009 May 1;144(1):48-53. doi: 10.1016/j.ejogrb.2009.02.001, http://dx.doi.org/10.1016/j.ejogrb.2009.02.001

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title = "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.",

author = "Kristine Lossl and Anne Loft and Freiesleben, {Nina L C} and Susanne Bangsb{\o}ll and Andersen, {Claus Yding} and Pedersen, {Anette T} and Dorthe Hartwell and Andersen, {Anders Nyboe} and Kristine L{\o}ssl and Anne Loft and Freiesleben, {Nina L C} and Susanne Bangsb{\o}ll and Andersen, {Claus Yding} and Pedersen, {Anette T} and Dorthe Hartwell and Andersen, {Anders Nyboe}",

note = "Keywords: Adult; Aromatase Inhibitors; CA-125 Antigen; Down-Regulation; Drug Therapy, Combination; Endometriosis; Estrogens; Female; Fertilization in Vitro; Gonadotropin-Releasing Hormone; Goserelin; Humans; Nitriles; Pilot Projects; Pregnancy; Pregnancy Outcome; Prospective Studies; Triazoles; Uterine Diseases",

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T1 - Combined down-regulation by aromatase inhibitor and GnRH-agonist in IVF patients with endometriomas-A pilot study

AU - Lossl, Kristine

AU - Loft, Anne

AU - Freiesleben, Nina L C

AU - Bangsbøll, Susanne

AU - Andersen, Claus Yding

AU - Pedersen, Anette T

AU - Hartwell, Dorthe

AU - Andersen, Anders Nyboe

AU - Løssl, Kristine

AU - Loft, Anne

AU - Freiesleben, Nina L C

AU - Bangsbøll, Susanne

AU - Andersen, Claus Yding

AU - Pedersen, Anette T

AU - Hartwell, Dorthe

AU - Andersen, Anders Nyboe

N1 - Keywords: Adult; Aromatase Inhibitors; CA-125 Antigen; Down-Regulation; Drug Therapy, Combination; Endometriosis; Estrogens; Female; Fertilization in Vitro; Gonadotropin-Releasing Hormone; Goserelin; Humans; Nitriles; Pilot Projects; Pregnancy; Pregnancy Outcome; Prospective Studies; Triazoles; Uterine Diseases

PY - 2009/5/1

Y1 - 2009/5/1

N2 - 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.

AB - 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.

U2 - 10.1016/j.ejogrb.2009.02.001

DO - 10.1016/j.ejogrb.2009.02.001

M3 - Journal article

C2 - 19261371

SN - 0301-2115

VL - 144

SP - 48

EP - 53

JO - European Journal of Obstetrics, Gynecology and Reproductive Biology

JF - European Journal of Obstetrics, Gynecology and Reproductive Biology

IS - 1

ER -

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

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