Comparison of in vitro fertilization cycles stimulated with 20 mg letrozole daily versus high‐dose gonadotropins in Rotterdam Consensus ultra‐poor responders: A proof of concept

Objective To evaluate if high‐dose letrozole can be used successfully to stimulate poor responders for in vitro fertilization (IVF). Methods This was a retrospective study conducted at a university hospital reproductive center. The analysis included women who were up to 42 years of age and were Rotterdam Consensus poor responders. A total of 247 patients received gonadotropins (300–450 IU daily) and 62 patients were stimulated with letrozole (20 mg daily) as part of an antagonist IVF protocol. Results The use of 20 mg of letrozole decreased the total dose of gonadotropins used (645 ± 175 IU vs. 5360 ± 1028 IU, P = 0.001) and resulted in lower costs of stimulation medications ($ 555.56 ± $ 150 vs. $ 4616 ± $ 885 Canadian Dollars; P = 0.001). Pregnancy per cycle (14.5%) and per transfer (16%) rates were legitimate for this low prognosis group and may have been better than or similar to those with high‐dose gonadotropins. The rate of cycle cancellation may have been reduced in the letrozole versus gonadotropin group (11% vs. 38%; P = 0.001). Conclusion Letrozole (20 mg daily) may be used to reduce the cost of ovarian stimulation in ultra‐poor responders, significantly reducing the cost of the IVF cycle with probably at least similar outcomes to high‐dose gonadotropins. Synopsis Letrozole 20 mg daily may be used to reduce the cost of ovarian stimulation in ultra‐poor responders.