|
|
Clinical effect of different doses of Letrozole combined with low-dose HMG on infertile patients with polycystic ovary syndrome#br# |
HE Shan1 LIU Dayan2 NING Yan3 CHEN Pengdian3 JIANG Shaoyan1 MA Fei3 WU Jiaman3 WU Fangting1 |
1.Department of Pharmacy, the Affiliated Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Guangdong Province, Shenzhen 518028, China;
2.Reproductive Center, the Affiliated Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Guangdong Province, Shenzhen 518028, China;
3.Department of Traditional Chinese Medicine, the Affiliated Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Guangdong Province, Shenzhen 518028, China |
|
|
Abstract Objective To explore the effect of different doses of Letrozole combined with low-dose human menopausal gonadotropin (HMG) on infertile patients with polycystic ovary syndrome (POCS), and to provide guidance for clinical ovulation promotion programs of patients. Methods A total of 189 infertility patients with PCOS who were received routine ovulation induction treatment in Reproductive Center, the Affiliated Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University from January 2018 and December 2020 as research subjects. They were divided into group A (Letrozole 2.5 mg), group B (Letrozole 5.0 mg), and group C (Letrozole 7.5 mg). After five days of Letrozole oral administration from two to five days of menstruation, HMG was intramuscular injected. The levels of luteinizing hormone (LH), estrdiol (E2), and testoserone (T) in each group on human chorionic gonadotrophin (HCG) day; number of follicular maturation days, doses and days of HMG, number of follicular development, endometrial thickness, and the proportion of patients with clinical pregnancy rate, number of miscarriages, number of biochemical pregnancies, number of ovarian hyperstimulation syndrome (OHSS), and number of multiple pregnancies were observed and compared. Results There were no significant differences in endometrial thickness and maximum follicular diameter among three groups on HCG days (P > 0.05); the number of follicular maturation days and days of HMG in groups B and C were longer than those in group A, the doses of HMG were lower than those in group A, and the number of follicles ≥18 mm and ≥15 mm in HCG days were more than those in group A, and the differences were statistically significant (P < 0.05). There were no significant differences in LH and T levels among three groups in HCG days (P > 0.05); E2 levels of HCG days in group B and C were higher than those in group A, and the differences were statistically significant (P < 0.05). No OHSS occurred in three groups. There were no significant differences in the proportion of patients with clinical pregnancy, multiple pregnancies, miscarriages, and biochemical pregnancies among three groups (P > 0.05). Conclusion Different doses of Letrozole combined with low-doses of HMG can effectively improve follicular growth and development in patients with PCOS ovulation disorder. In PCOS infertile patients, Letrozole 5.0 mg is taken orally from the two to five days of menstruation for five days, after five days, combined with HMG, the treatment effect is satisfactory, the number of ovulation induction days is short, the incidence of OHSS is low, and the clinical pregnancy rate is high, which had high clinical application value.
|
|
|
|
|
[1] Azziz R. Polycystic Ovary Syndrome [J]. Obstet Gynecol,2018,132(2):321-336.
[2] Rocha AL,Oliveira FR,Azevedo RC,et al. Recent advances in the understanding and management of polycystic ovary syndrome [J]. F1000Res,2019,8:F1000 Faculty Rev-565.
[3] Costello M,Garad R,Hart R,et al. A Review of First Line Infertility Treatments and Supporting Evidence in Women with Polycystic Ovary Syndrome [J]. Med Sci(Basel),2019, 7(9):95.
[4] Yang AM,Cui N,Sun YF,et al. Letrozole for Female Infertility [J]. Front Endocrinol(Lausanne),2021,12:676133.
[5] Chen Z,Zhang M,Qiao Y,et al. Effects of letrozole in combination with low-dose intramuscular injection of human menopausal gonadotropin on ovulation and pregnancy of 156 patients with polycystic ovary syndrome [J]. Pak J Med Sci,2016,32(6):1434-1438.
[6] Franik S,Eltrop SM,Kremer JAM,et al. Aromatase inhibitors(letrozole)for subfertile women with polycystic ovary syndrome [J]. Cochrane Database Syst Rev,2018,5(5):CD010287.
[7] Rotterdam ESHRE/ASRM-Sponsored PCOS consensus workshop group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome(PCOS)[J]. Hum Reprod,2004,19(1):41-47.
[8] 张素萍.来曲唑治疗不同体质量指数多囊卵巢综合征患者临床分析[D].济南:山东大学,2018.
[9] Lizneva D,Suturina L,Walker W,et al. Criteria,prevalence,and phenotypes of polycystic ovary syndrome [J]. Fertil Steril,2016,106(1):6-15.
[10] Wang R,Li W,Bordewijk EM,et al. First-line ovulation induction for polycystic ovary syndrome:an individual participant data meta-analysis [J]. Hum Reprod Update,2019,25(6):717-732.
[11] Mitwally M,Casper R. The aromatase inhibitor,letrozole:a promising aternative for clomiphene citrate for induction of ovulation [J]. Fertil Steril,2000,74(3):S35.
[12] Nguyen TT,Doan HT,Quan LH,et al. Effect of letrozole for ovulation induction combined with intrauterine insemination on women with polycystic ovary syndrome [J]. Gynecol Endocrinol,2020,36(10):860-863.
[13] Sakar MN,Oglak SC. Letrozole is superior to clomiphene citrate in ovulation induction in patients with polycystic ovary syndrome [J]. Pak J Med Sci,2020,36(7):1460-1465.
[14] 潘烨,王泽,冯海英,等.来曲唑促排卵研究进展[J].中国实用妇科与产科杂志,2018,3:340-343.
[15] Requena A,Herrero J,Landeras J,et al. Use of letrozole in assisted reproduction:a systematic review and meta-analysis [J]. Hum Reprod Update,2008,14(6):571-582.
[16] Zhao Y,Ruan X,Mueck AO. Letrozole combined with low dose highly purified HMG for ovulation induction in clomiphene citrate-resistant infertile Chinese women with polycystic ovary syndrome:a prospective study [J]. Gynecol Endocrinol,2017,33(6):462-466.
[17] Garcia-Velasco JA,Moreno L,Pacheco A,et al. The aromatase inhibitor letrozole increases the concentration of intraovarian androgens and improves in vitro fertilization outcome in low responder patients:a pilot study [J]. Fertil Steril,2005,84(1):82-87.
[18] 肖楠,赵华,靳镭,等.不同剂量来曲唑联合人绝经期促性腺激素对多囊卵巢综合征患者促排卵治疗妊娠结局的比较[J].发育医学电子杂志,2015,4:224-228.
[19] Ramezanzadeh F,Nasiri R,Sarafraz Yazdi M,et al. A randomized trial of ovulation induction with two different doses of Letrozole in women with PCOS [J]. Arch Gynecol Obstet,2011,284:1029-1034.
[20] Shi S,Hong T,Jiang F,et al. Letrozole and human menopausal gonadotropin for ovulation induction in clomiphene resistance polycystic ovary syndrome patients:A randomized controlled study [J]. Medicine(Baltimore),2020,99(4):e18383.
[21] Thomas S,Woo I,Ho J,et al. Ovulation rates in a stair-step protocol with Letrozole vs clomiphene citrate in patients with polycystic ovarian syndrome [J]. Contracept Reprod Med,2019,4:20.
[22] Lin J,Wang N,Huang J,et al. Pregnancy And Neonatal Outcomes Of hMG Stimulation With Or Without Letrozole In Endometrial Preparation For Frozen-Thawed Embryo Transfer In Ovulatory Women:A Large Retrospective Cohort Study [J]. Drug Des Devel Ther,2019, 13:3867-3877.
[23] Zhang J,Liu H,Wang Y,et al. Letrozole use during frozen embryo transfer cycles in women with polycystic ovary syndrome [J]. Fertil Steril,2019,112(2):371-377.
[24] 孙文洁,林奕,吕江涛,等.不同剂量来曲唑促排卵效果及对内膜、性激素影响的研究[J].重庆医科大学学报,2017,3:319-322.
[25] Tshzmachyan R,Hambartsoumian E. The role of Letrozole(LE)in controlled ovarian stimulation(COS) in patients at high risk to develop ovarian hyper stimulation syndrome(OHSS). A prospective randomized controlled pilot study [J]. J Gynecol Obstet Hum Reprod,2020,49(2):101643. |
|
|
|