Fertility Center, Yerevan State Medical University, 41/7 Moldovakan street, Nor Nork, 0062, Yerevan, Armenia.
J Gynecol Obstet Hum Reprod. 2020 Feb;49(2):101643. doi: 10.1016/j.jogoh.2019.101643. Epub 2019 Sep 26.
Recently, it has been shown that PCOS patients with extremely high anti-Mullerian hormone (AMH) level are more likely to experience OHSS during IVF, compared to PCOS patients with lower AMH level. While recent data questioned the effect of Letrozole (LE) on the occurrence of OHSS in non-PCOS patients, it role in PCOS patients with very high AMH level was never investigated in a prospective manners. Hence, our main objective was to evaluate the clinical outcome of PCOS patients at very high risk for OHSS undergoing two different COS protocols (with or without LE).
A prospective randomized controlled study (RCT) of 51 patients with specifically high levels of AMH undergoing one of two COS protocols. The control group (group A) consisted of 24 PCOS women who received low-dose gonadotropins using the multiple-dose GnRH-antagonist protocol, GnRH agonist-triggered and "freeze all". The study group (group B) consisted of 24 women with PCOS who received the same protocol combined with LE. High risk criteria for OHSS were: PCOS patients with low BMI, young age, and extremely high level of serum AMH (inclusion criteria for AMH > 50 pmol/L).
Cumulative live birth rates per retrieval were similar in both groups. While no single case of severe OHSS was observed in, in the study group (group B), the rate of moderate and mild OHSS was 5 times lower compared to the control group (P < 0.05).
In PCOS patients with extremely high AMH levels the LE co-administration to GnRH-Ant protocols results in reduced incidence of OHSS than conventional GnRH-Ant protocols. LE co-administration may prove to be highly effective in preventing OHSS, even in the women who are at high risk to these dangerous complications.
最近的研究表明，与 AMH 水平较低的 PCOS 患者相比，抗缪勒管激素（AMH）水平极高的 PCOS 患者在接受 IVF 时更有可能发生 OHSS。虽然最近的数据对来曲唑（LE）对非 PCOS 患者发生 OHSS 的影响提出了质疑，但它在 AMH 水平极高的 PCOS 患者中的作用从未以前瞻性方式进行过研究。因此，我们的主要目标是评估处于 OHSS 极高风险的 PCOS 患者接受两种不同的 COs 方案（有或没有 LE）的临床结局。
对 51 名 AMH 水平特别高的 PCOS 患者进行前瞻性随机对照研究（RCT）。对照组（A 组）由 24 名接受低剂量促性腺激素的 PCOS 妇女组成，采用 GnRH 拮抗剂多剂量方案，GnRH 激动剂触发和“全部冷冻”。研究组（B 组）由 24 名接受相同方案联合 LE 的 PCOS 妇女组成。OHSS 的高危标准为：BMI 低、年龄轻、血清 AMH 水平极高的 PCOS 患者（纳入标准为 AMH>50pmol/L）。
两组的每取卵周期活产率相似。虽然研究组（B 组）中没有观察到一例严重 OHSS，但中度和轻度 OHSS 的发生率比对照组低 5 倍（P<0.05）。
在 AMH 水平极高的 PCOS 患者中，与常规 GnRH 拮抗剂方案相比，LE 联合 GnRH 拮抗剂方案可降低 OHSS 的发生率。LE 联合治疗可能在预防 OHSS 方面非常有效，即使是在这些高危妇女中也是如此。
