Thesis (Ph.D.) - Cairo University - Faculty of Medicine - Department of Gynecology and Obstetrics

Objective To evaluate the efficacy of extended letrozole co-treatment with GnRHantagonist protocol in ovarian stimulation of poor responder patients undergoing IVF-ET. Methods This prospective, double blinded, two arm randomized controlled trial was conducted at assisted conception unit of Obstetrics and Gynecology department, Cairo university, Egypt, between May 2018 and January 2020. The study included 106 fresh IVF-ET cycles from 106 poor responders according to the Bologna criteria. Patients were randomized in 1: 1 ratio to extended letrozole regimen / GnRH antagonist protocol group and GnRH antagonist protocol group. In extended letrozole regimen / GnRH ant group letrozole was administered starting on cycle day 1 for 8 consecutive days.The dose of letrozole was (5 mg/day during the first 5 days of cycle and 2.5 mg/ day during the subsequent 3 days). In GnRH antagonist group, placebo tablets were administered. In both groups, GnRH antagonist (Cetrorelix acetate) 0.25 mg S.C. once daily was started when the leading follicle was 14 mm in mean diameter. Results Total cycle cancellation rate and cycle cancelation rate due to poor response were comparable between both groups (28.3% Vs. 30.19%, P value = 0.831 and 16.18% Vs 20.59%, P value = 0.605, respectively). The number of follicles {u2265}18 mm, oocytes retrieved, metaphase II oocyte, 2PN embryos, transferred embryos, peak estradiol level and quality of VII transferred embryos were comparable between both groups

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