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Off-label use: aromatase inhibitors show promise in fertility Tx.(Gynecology)
LAS VEGAS -- Aromatase inhibitors may be the answer for women in whom clomiphene fails to induce ovulation, Dr. Robert F. Casper said at the Fifth World Congress on Controversies in Obstetrics, Gynecology, and Infertility.
Studies have suggested that the aromatase inhibitor letrozole is at least as effective as clomiphene in inducing ovulation in women with polycystic ovary syndrome (PCOS) and is associated with a higher clinical pregnancy rate and fewer multiple pregnancies, said Dr. Casper of the division of reproductive sciences, Mount Sinai Hospital, Toronto, and the University of Toronto.
Other studies have shown that combining an aromatase inhibitor with FSH injections can induce ovulation, decrease the FSH dose needed for ovarian stimulation, and enhance fertility in women undergoing treatment for idiopathic infertility.
Aromatase inhibitors--letrozole, arimidex, and exemestane--have been associated with a decline in blood and tissue levels of estrogen to as low as menopausal levels in some patients.
Dr. Casper and his associates hypothesized that administration of an aromatase inhibitor early in the menstrual cycle would mimic the central action of clomiphene without depleting estrogen receptors. The ensuing decrease in circulating estrogen would diminish the negative feedback on FSH, resulting in higher FSH levels, stimulation of follicle development, and ovulation.
In an observational, pilot cohort study, Dr. Casper and Dr. Mohamed Mitwally offered combination therapy ...
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