LETROZOLE IN THE MANAGEMENT OF INFERTILITY

Letrozole a wonderful drug has evolved over the year from anti cancer drug to a fertility drug

1. DR G A RAMA RAJU Letrozole In Infertility

2. Contents

3. Estimates of infertility vary widely among Indian states from Prevalence of primary infertility in India is between 3.9 & 16.8 affecting about 12 million couples!

4. DICOVERY & ROLE OF AROMATASE INHIBITORS Angela-brodie If you have something you think is a good idea, stick to it,” 

5. Robert Casper pioneering work on letrozole and ovulation

6. Letrozole banned in 2011 TERTOGENCITY 2005

7. After 5 years, Ban revoked

8. After 5 years, Ban revoked

9. Ideal Ovulation Induction Drug Requena A, Herrero J, Landeras J, Navarro E, Neyro J, Salvador C et al. Use of letrozole in assisted reproduction: a systematic review and meta-analysis. Human Reproduction Update. 2008;14(6):571-582 .

10. Inhibit or inactivate Aromatase Aromatase Cytochrome P-450 superfamily CYP19 gene Rate limiting step in estrogen production, that is, conversion of androgens (androstenedione and testosterone) into estrogens (estrone and estradiol, respectively). Requena A, Herrero J, Landeras J, Navarro E, Neyro J, Salvador C et al. Use of letrozole in assisted reproduction: a systematic review and meta-analysis. Human Reproduction Update. 2008;14(6):571-582.

11. Classification of aromatase inhibitors Requena A, Herrero J, Landeras J, Navarro E, Neyro J, Salvador C et al. Use of letrozole in assisted reproduction: a systematic review and meta-analysis. Human Reproduction Update. 2008;14(6):571-582.

12. Mechanism of action (Clomiphene citrate and letrozole)

13. Mechanism of action of Letrozole

14. Difference between CC and letrozole

15. Clarification article In this double-blind, multicentre trial, authors randomly assigned 750 women, in a 1:1 ratio, to receive letrozole or clomiphene for up to five treatment cycles, with visits to determine ovulation and pregnancy, followed by tracking of pregnancies N Engl J Med 2014;371:119-29

16. Outcomes with Regard to Live Birth, Ovulation, Pregnancy, Pregnancy Loss, and Fecundity. N Engl J Med 2014;371:119-29

17. Kaplan–Meier Curves for Live Birth. N Engl J Med 2014;371:119-29

18. Adverse Drug Events As compared with clomiphene, letrozole was associated with higher live-birth and ovulation rates among infertile women with the polycystic ovary syndrome N Engl J Med 2014;371:119-29

19. Letrozole Requena A, Herrero J, Landeras J, Navarro E, Neyro J, Salvador C et al. Use of letrozole in assisted reproduction: a systematic review and meta-analysis. Human Reproduction Update. 2008;14(6):571-582.

20. Letrozole use Requena A, Herrero J, Landeras J, Navarro E, Neyro J, Salvador C et al. Use of letrozole in assisted reproduction: a systematic review and meta-analysis. Human Reproduction Update. 2008;14(6):571-582.

21. Letrozole use The regimen of letrozole + HMG is more effective and safer than CC + HMG or HMG alone for ovulation induction in cases of CC resistance Requena A, Herrero J, Landeras J, Navarro E, Neyro J, Salvador C et al. Use of letrozole in assisted reproduction: a systematic review and meta-analysis. Human Reproduction Update. 2008;14(6):571-582.

22. Therapeutic use of aromatase inhibitor Requena A, Herrero J, Landeras J, Navarro E, Neyro J, Salvador C et al. Use of letrozole in assisted reproduction: a systematic review and meta-analysis. Human Reproduction Update. 2008;14(6):571-582.

23. Dose regimen of Letrozole Requena A, Herrero J, Landeras J, Navarro E, Neyro J, Salvador C et al. Use of letrozole in assisted reproduction: a systematic review and meta-analysis. Human Reproduction Update. 2008;14(6):571-582.

24. Contraindications of letrozole therapy Requena A, Herrero J, Landeras J, Navarro E, Neyro J, Salvador C et al. Use of letrozole in assisted reproduction: a systematic review and meta-analysis. Human Reproduction Update. 2008;14(6):571-582.

25. Side effects of Letrozole therapy Requena A, Herrero J, Landeras J, Navarro E, Neyro J, Salvador C et al. Use of letrozole in assisted reproduction: a systematic review and meta-analysis. Human Reproduction Update. 2008;14(6):571-582.

26. ACOG Recommendations

27. AACE and ESC Recommendations

28. Role of aromatase inhibitors (letrozole) in different types of infertility

29. Anovulatory women with PCOS Requena A, Herrero J, Landeras J, Navarro E, Neyro J, Salvador C et al. Use of letrozole in assisted reproduction: a systematic review and meta-analysis. Human Reproduction Update. 2008;14(6):571-582.

30. Unexplained infertility Requena A, Herrero J, Landeras J, Navarro E, Neyro J, Salvador C et al. Use of letrozole in assisted reproduction: a systematic review and meta-analysis. Human Reproduction Update. 2008;14(6):571-582 .

31. Clomiphene citrate resistant PCOS Requena A, Herrero J, Landeras J, Navarro E, Neyro J, Salvador C et al. Use of letrozole in assisted reproduction: a systematic review and meta-analysis. Human Reproduction Update. 2008;14(6):571-582 .

32. Aromatase inhibitors VERSUS Laparoscopy ovarian drilling Requena A, Herrero J, Landeras J, Navarro E, Neyro J, Salvador C et al. Use of letrozole in assisted reproduction: a systematic review and meta-analysis. Human Reproduction Update. 2008;14(6):571-582.

33. Aromatase inhibitors for IUI

34. ROLE IN IVF

35. Aromatase inhibitors for IVF Requena A, Herrero J, Landeras J, Navarro E, Neyro J, Salvador C et al. Use of letrozole in assisted reproduction: a systematic review and meta-analysis. Human Reproduction Update. 2008;14(6):571-582.

36. Ohss evolving concepts

37. REDUCES OHSS

38. YOUNG AGE-CANCER .IVF Endocrine

39. Use of letrozole for fertility preservation in oncological patients Requena A, Herrero J, Landeras J, Navarro E, Neyro J, Salvador C et al. Use of letrozole in assisted reproduction: a systematic review and meta-analysis. Human Reproduction Update. 2008;14(6):571-582.

40. Summary Requena A, Herrero J, Landeras J, Navarro E, Neyro J, Salvador C et al. Use of letrozole in assisted reproduction: a systematic review and meta-analysis. Human Reproduction Update. 2008;14(6):571-582.

41. GOOD ARTICLE ON UNDERSTADING LETRIZOLE EVOLUTION

42. Video lecture of the talk. lecture