Arya Sushila, Kupesic-Plavsic Sanja, Mulla Zuber D, Dwivedi Alok K, Crisp Zeni, Jose Jisha, Noble Luis S
Department of Obstetrics and Gynecology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, 4801 Alberta Ave, El Paso, TX, 79905, USA.
Department of Obstetrics and Gynecology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, 5001 El Paso Drive, El Paso, TX, 79905, USA.
Eur J Obstet Gynecol Reprod Biol. 2017 Nov;218:123-128. doi: 10.1016/j.ejogrb.2017.09.023. Epub 2017 Sep 23.
To assess the effect of letrozole in combination with low dose gonadotropins for ovulation induction in anovulatory infertility from polycystic ovary syndrome (PCOS) and controlled ovarian stimulation for endometriosis, and unexplained infertility patients.
Retrospective cohort study in a setting of private Reproductive Endocrinology and Infertility Clinic affiliated with the University. Three hundred couples (650 cycles) requiring OI/COS for PCOS (92 patients, 195 cycles), endometriosis (89 patients, 217 cycles), and unexplained infertility (119 patients, 238 cycles). Patients received 2.5mg or 5mg letrozole for 5days (D3-D7) and recombinant follicle-stimulating hormone on alternating D3-D7 and human menopausal gonadotropin-highly purified alternating D5-D10 until growth of ideally 2 mature follicles. Ovulation was triggered with 10,000 IU of HCG. Maximum number of cycles per patient was four.
Main outcome measures were clinical pregnancy rates, multiple order pregnancy rates, miscarriage rates, number of follicles and endometrial thickness on the day of HCG administration. The cumulative incidence of pregnancy was estimated as 35% (95%CI: 29%-41%) overall and was highest in patients with PCOS (36.6%), followed by unexplained infertility (34.6%) and endometriosis (32.5%). The pregnancy rates per cycle in PCOS, endometriosis and unexplained infertility patients were 17%, 13.2% and 17.2% respectively, no statistically significant difference between the groups. There were three twin pregnancies in PCOS, and one in unexplained infertility group. Monofolliculogenesis was noted in 48% of patients.
CONCLUSION(S): Letrozole-low dose gonadotropins combination appears to be effective across different causes of infertility for superovulation. The letrozole-low dose gonadotropin combination resulted in high rate of monofolliculogenesis, low occurrence of multiple gestations and no case of OHSS or cycle cancellation.
评估来曲唑联合低剂量促性腺激素用于多囊卵巢综合征（PCOS）所致无排卵性不孕症的促排卵、子宫内膜异位症的控制性卵巢刺激以及不明原因不孕症患者的效果。
在一所大学附属的私立生殖内分泌与不孕症诊所进行回顾性队列研究。300对夫妇（650个周期）因PCOS（92例患者，195个周期）、子宫内膜异位症（89例患者，217个周期）和不明原因不孕症（119例患者，238个周期）需要进行促排卵/控制性卵巢刺激。患者在第3 - 7天接受2.5mg或5mg来曲唑治疗5天，并在第3 - 7天交替使用重组促卵泡激素，在第5 - 10天交替使用人绝经期促性腺激素 - 高纯度制剂，直至理想地生长出2个成熟卵泡。用10000IU的HCG触发排卵。每位患者的最大周期数为4个。
主要结局指标为临床妊娠率、多胎妊娠率、流产率、HCG给药当天的卵泡数和子宫内膜厚度。总体妊娠累积发生率估计为35%（95%CI：29% - 41%），在PCOS患者中最高（36.6%），其次是不明原因不孕症患者（34.6%）和子宫内膜异位症患者（32.5%）。PCOS、子宫内膜异位症和不明原因不孕症患者的每个周期妊娠率分别为17%、13.2%和17.2%，组间无统计学显著差异。PCOS组有3例双胎妊娠，不明原因不孕症组有1例。48%的患者出现单卵泡发育。
来曲唑 - 低剂量促性腺激素联合方案似乎对不同原因的不孕症超排卵有效。来曲唑 - 低剂量促性腺激素联合方案导致单卵泡发育率高、多胎妊娠发生率低，且无卵巢过度刺激综合征或周期取消的病例。
