en تأثیر درمان همزمان با لتروزول و گنادوتروپین بر میزان موفقیت لقاح آزمایشگاهی (IVF) در زنان مبتلا به آندومتریوز: کارآزمایی بالینی تصادفی دوسوکور Fertility & Infertility Original Article Original Article <div style="text-align: justify;"><span style="font-size:12pt"><span style="text-justify:inter-ideograph"><span style="direction:rtl"><span style="unicode-bidi:embed"><span style="font-family:&quot;Times New Roman&quot;,&quot;serif&quot;"><b><span lang="FA" style="font-size:11.0pt"><span style="font-family:&quot;B Mitra&quot;">مقدمه: </span></span></b><span lang="FA" style="font-size:11.0pt"><span style="font-family:&quot;B Mitra&quot;">دلایل عمده ناباروری در زنان مبتلا به آندومتریوز، تغییر در فولیکولوژنز، استروئیدوژنز و اختلال در لقاح، کاهش کیفیت تخمک و جنین، و نقص &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;لانه&shy;گزینی است.</span></span><span dir="LTR" style="font-size:11.0pt"><span style="font-family:&quot;Arial&quot;,&quot;sans-serif&quot;"></span></span></span></span></span></span></span><br> <span style="font-size:12pt"><span style="text-justify:inter-ideograph"><span style="direction:rtl"><span style="unicode-bidi:embed"><span style="font-family:&quot;Times New Roman&quot;,&quot;serif&quot;"><b><span lang="FA" style="font-size:11.0pt"><span style="font-family:&quot;B Mitra&quot;">هدف: </span></span></b><span lang="FA" style="font-size:11.0pt"><span style="font-family:&quot;B Mitra&quot;">مقایسه&shy;ی میزان موفقیت چرخه لقاح آزمایشگاهی (</span></span><span dir="LTR" style="font-size:10.0pt">IVF</span><span lang="FA" style="font-size:11.0pt"><span style="font-family:&quot;B Mitra&quot;">) در زنان مبتلا به آندومتریوز در گروه درمانی با لتروزول و گنادوتروپین و گروه گنادوتروپین به تنهایی بود.</span></span></span></span></span></span></span><br> <span style="font-size:12pt"><span style="text-justify:inter-ideograph"><span style="direction:rtl"><span style="unicode-bidi:embed"><span style="font-family:&quot;Times New Roman&quot;,&quot;serif&quot;"><b><span lang="FA" style="font-size:11.0pt"><span style="font-family:&quot;B Mitra&quot;">مواد و روش &shy;ها: </span></span></b><span lang="FA" style="font-size:11.0pt"><span style="font-family:&quot;B Mitra&quot;">این مطالعه کارآزمایی بالینی تصادفی دو سو کور بر روی 94 زن مبتلا به آندومتریوز (47 نفر در گروه لتروزول + گنادوتروپین (</span></span><span dir="LTR" style="font-size:10.0pt">LA</span><span lang="FA" style="font-size:11.0pt"><span style="font-family:&quot;B Mitra&quot;">) و 47</span></span> <span lang="FA" style="font-size:11.0pt"><span style="font-family:&quot;B Mitra&quot;">نفر در گروه گنادوتروپین (</span></span><span dir="LTR" style="font-size:10.0pt">PA</span><span lang="FA" style="font-size:11.0pt"><span style="font-family:&quot;B Mitra&quot;">)) که کاندیدای </span></span><span dir="LTR" style="font-size:10.0pt">IVF</span> <span lang="FA" style="font-size:11.0pt"><span style="font-family:&quot;B Mitra&quot;">در بیمارستان یاس، در سال 1400 بودند، انجام شد.</span></span> <span lang="FA" style="font-size:11.0pt"><span style="font-family:&quot;B Mitra&quot;">برای همه شرکت</span></span><span dir="LTR" style="font-size:11.0pt"><span style="font-family:&quot;Arial&quot;,&quot;sans-serif&quot;">&shy;</span></span><span lang="FA" style="font-size:11.0pt"><span style="font-family:&quot;B Mitra&quot;">کنندگان، پروتکل آگونیست طولانی استفاده شد. در هر دو گروه, هورمون آزادکننده گنادوتروپین در اواسط مرحله&shy;ی لوتئال تجویز شد. از روز سوم چرخه قاعدگی, گنادوتروپین شروع و دوز آن بر اساس سن بیمار، میزان هورمون آنتی&shy;مولرین و هورمون محرک فولیکولی تنظیم شد. همچنین از روز سوم چرخه قاعدگی، 5 میلی&shy;گرم لتروزول روزانه به مدت 5 روز برای گروه </span></span><span dir="LTR" style="font-size:10.0pt">LA</span> <span lang="FA" style="font-size:11.0pt"><span style="font-family:&quot;B Mitra&quot;">تجویز شد، در حالی که دارونما برای گروه </span></span><span dir="LTR" style="font-size:10.0pt">PA</span> <span lang="FA" style="font-size:11.0pt"><span style="font-family:&quot;B Mitra&quot;">روزانه به مدت 5 روز تجویز شد. پس از انتقال جنین، میزان بارداری در دو گروه بررسی شد.</span></span></span></span></span></span></span><br> <span style="font-size:12pt"><span style="text-justify:inter-ideograph"><span style="direction:rtl"><span style="unicode-bidi:embed"><span style="font-family:&quot;Times New Roman&quot;,&quot;serif&quot;"><b><span lang="FA" style="font-size:11.0pt"><span style="font-family:&quot;B Mitra&quot;">نتایج: </span></span></b><span lang="FA" style="font-size:11.0pt"><span style="font-family:&quot;B Mitra&quot;">دوز گنادوتروپین (01/0 </span></span><span lang="FA" style="font-size:10.0pt">> </span><span dir="LTR" style="font-size:10.0pt">p</span><span lang="FA" style="font-size:11.0pt"><span style="font-family:&quot;B Mitra&quot;">) و سطح استرادیول (02/0 </span></span><span lang="FA" style="font-size:10.0pt">= </span><span dir="LTR" style="font-size:10.0pt">p</span><span lang="FA" style="font-size:11.0pt"><span style="font-family:&quot;B Mitra&quot;">) در روز تجویز گنادوتروپین جفتی انسانی (</span></span><span dir="LTR" style="font-size:10.0pt">hCG</span><span lang="FA" style="font-size:11.0pt"><span style="font-family:&quot;B Mitra&quot;">) در گروه </span></span><span dir="LTR" style="font-size:10.0pt">LA</span> <span lang="FA" style="font-size:11.0pt"><span style="font-family:&quot;B Mitra&quot;">در مقایسه با گروه </span></span><span dir="LTR" style="font-size:10.0pt">PA</span> <span lang="FA" style="font-size:11.0pt"><span style="font-family:&quot;B Mitra&quot;">به طور قابل توجهی کمتر بود. انتقال جنین برای 32 زن انجام شد. هیچ تفاوت معنی&shy;داری در مورد بارداری بیوشیمیایی یا بالینی بین گروه&shy;های مورد مطالعه مشاهده نشد (72/0 </span></span><span lang="FA" style="font-size:10.0pt">= </span><span dir="LTR" style="font-size:10.0pt">p</span><span lang="FA" style="font-size:11.0pt"><span style="font-family:&quot;B Mitra&quot;">).</span></span></span></span></span></span></span><br> <span style="font-size:12pt"><span style="text-justify:inter-ideograph"><span style="direction:rtl"><span style="unicode-bidi:embed"><span style="font-family:&quot;Times New Roman&quot;,&quot;serif&quot;"><b><span lang="FA" style="font-size:11.0pt"><span style="font-family:&quot;B Mitra&quot;">نتیجه &shy;گیری:</span></span></b> <span lang="FA" style="font-size:11.0pt"><span style="font-family:&quot;B Mitra&quot;">استفاده از لتروزول به عنوان درمان همزمان در چرخه </span></span><span dir="LTR" style="font-size:10.0pt">IVF</span> <span lang="FA" style="font-size:11.0pt"><span style="font-family:&quot;B Mitra&quot;">در زنان مبتلا به آندومتریوز می&shy;تواند دوز گنادوتروپین و سطح استرادیول را با همان میزان حاملگی, به طور قابل توجهی کاهش دهد.</span></span></span></span></span></span></span></div> <div style="text-align: justify;"><span style="font-size:11pt"><span style="line-height:normal"><span style="font-family:Calibri,&quot;sans-serif&quot;"><b><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,&quot;serif&quot;">Background: </span></span></b><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,&quot;serif&quot;">The common causes of infertility in women with endometriosis are folliculogenesis alternation, steroidogenesis and fertilization impairment, oocyte and embryo quality reduction, and implantation defect.</span></span></span></span></span><br> <span style="font-size:11pt"><span style="line-height:normal"><span style="font-family:Calibri,&quot;sans-serif&quot;"><b><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,&quot;serif&quot;">Objective:</span></span></b><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,&quot;serif&quot;"> To compare in vitro fertilization (IVF) cycle success rates of women with endometriosis who were treated with letrozole + gonadotropin (LA) vs. placebo + gonadotropin (PA).</span></span></span></span></span><br> <span style="font-size:11pt"><span style="line-height:normal"><span style="font-family:Calibri,&quot;sans-serif&quot;"><b><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,&quot;serif&quot;">Materials and Methods: </span></span></b><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,&quot;serif&quot;">This double-blind, randomized clinical trial study was conducted with 94 infertile women with endometriosis (47 in the LA group and 47 in the PA group) who were candidates for IVF, from April-June 2021. For all participants, the long agonist protocol was applied. In both groups, gonadotropin-releasing hormone agonist was prescribed in the mid-luteal stage and from the third day of the cycle, and gonadotropin was started and its doses were regulated based on the patient&rsquo;s age, serum anti-Mullerian hormone and follicle-stimulating hormone. From the third day of the menstrual cycle,</span></span> <span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,&quot;serif&quot;">5 mg of letrozole daily for 5 days prescribed for LA group, while placebo prescribed for PA on the identical days and duration. After embryo transfer, biochemical and clinical pregnancy were measured in the 2 groups.</span></span></span></span></span><br> <span style="font-size:11pt"><span style="line-height:normal"><span style="font-family:Calibri,&quot;sans-serif&quot;"><b><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,&quot;serif&quot;">Results: </span></span></b><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,&quot;serif&quot;">The gonadotropin dosage (p < 0.01) and estradiol level (p = 0.02) on the human chorionic gonadotropin administration day were significantly lower in the LA group compared with in the PA group. Fetus transfer was done for 32 women. No significant differences were detected between the study groups regarding biochemical or clinical pregnancy (p = 0.72 for both). </span></span></span></span></span><br> <span style="font-size:11pt"><span style="line-height:normal"><span style="font-family:Calibri,&quot;sans-serif&quot;"><b><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,&quot;serif&quot;">Conclusion: </span></span></b><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,&quot;serif&quot;">Letrozole as a co-treatment drug in the IVF cycle of women with endometriosis can significantly reduce the gonadotropin dosage and estradiol level with the same pregnancy rates.</span></span></span></span></span></div> گنادوتروپین, روش­های کمک باروری, لتروزول, آندومتریوز. Gonadotropin-releasing hormone, Fertilization in vitro, Letrozole, Endometriosis. 483 490 http://ijrm.ir/browse.php?a_code=A-10-1542-2&slc_lang=en&sid=1 Mahbod Ebrahimi maeb214@yahoo.com 0000-0003-4722-7635 No Department of Obstetrics and Gynecology, Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran. Firoozeh Akbari Asbagh fasbagh_md@yahoo.com 0000-0001-5365-425X No Department of Obstetrics and Gynecology, Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran. Fatemeh Davari Tanha fatedavtanha@gmail.com 0000-0002-9465-6371 No Department of Obstetrics and Gynecology, Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran. Hamideh Pakniat hpakniat@qums.ac.ir 0000-0001-9513-7998 Yes Department of Obstetrics and Gynecology, Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran. Department of Obstetrics and Gynecology, Faculty of Medicine, Qazvin University of Medical Sciences, Qazvin, Iran. Elham Feizabad elhamfeizabad@gmail.com 0000-0002-0372-5897 No Department of Obstetrics and Gynecology, Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran. Yasin Rasouli yrasouli1@yahoo.com 0000-0002-8419-7079 No Faculty of Pharmacy, University of Szeged, Hungary.