The use of coenzyme Q10 and DHEA during IUI and IVF cycles in patients with decreased ovarian reserve.

OBJECTIVE: The objective of this study is to compare the combination of dehydroepiandrosterone (DHEA) and coenzyme Q10 (CoQ10) (D + C) with DHEA alone (D) in intrauterine insemination (IUI) and in vitro fertilization (IVF) cycles among patients with decreased ovarian reserve. METHODS: We retrospectively extracted data from patients charts treated by DHEA with/without CoQ10 during IUI or IVF between February 2006 and June 2014. Prestimulation parameters included age, BMI, day 3 FSH and antral follicular count (AFC). Ovarian response parameters included total gonadotropins dosage, peak serum estradiol, number of follicles > 16 mm and fertilization rate. Clinical outcomes included clinical and ongoing pregnancy rates. RESULTS: Three hundred and thirty IUI cycles involved D + C compared with 467 cycles of D; 78 IVF cycles involved D + C and 175 D. In both IUI and IVF, AFC was higher with D + C compared with D (7.4 ± 5.7 versus 5.9 ± 4.7, 8.2 ± 6.3 versus 5.2 ± 5, respectively, p < 0.05). D + C resulted in a more follicles > 16 mm during IUI cycles (3.3 ± 2.3 versus 2.9 ± 2.2, respectively, p = 0.01), while lower mean total gonadotropin dosage was administered after D + C supplementation compared with D (3414 ± 1141 IUs versus 3877 ± 1143 IUs respectively, p = 0.032) in IVF cycles. Pregnancy and delivery rates were similar for both IUI and IVF. CONCLUSION: D + C significantly increases AFC and improves ovarian responsiveness during IUI and IVF without a difference in clinical outcome.

Letrozole co-treatment in infertile women 40 years old and older receiving controlled ovarian stimulation and intrauterine insemination.

OBJECTIVE: To investigate the effect of a combination of letrozole and gonadotropins in advanced reproductive age infertile women who were treated with IUI. DESIGN: A retrospective case control study. SETTING: A private practice affiliated with an academic institute. PATIENT(S): Infertile women 40 years old and older who were treated with IUI and controlled ovarian hyperstimulation (COH) using either letrozole in combination with FSH (n = 90) or FSH alone (n = 69). MAIN OUTCOME MEASURE(S): Pregnancy rates (PR), mature follicles, serum levels of E(2), P, LH, endometrial thickness, rates of cycle cancellation, and FSH dose. RESULT(S): Pregnancy rates were comparable between the letrozole-FSH co-treatment group and the FSH alone group. Significantly fewer cycles were cancelled in the letrozole co-treatment group. The E(2) levels and the number of follicles were significantly higher in the FSH-only group. Serum levels of LH were significantly higher in the co-treatment group on cycle day 7. The P levels were significantly higher in the FSH alone group on the day of hCG administration. CONCLUSION(S): Letrozole co-treatment compared with using FSH alone has significantly modified the cycle characteristics without reducing PRs and could be of potential benefit in IUI cycles in older infertile women.