Cheng Z X, Kong G, Zhang C L, Zhao Y N
Center for Reproductive Medicine, Shenyang Women and Children's Hospital, Shenyang 110004, China.
Zhonghua Fu Chan Ke Za Zhi. 2020 Jan 25;55(1):9-14. doi: 10.3760/cma.j.issn.0529-567X.2020.01.003.
To explore and compare the preventive effect of using letrozole and gonadotropin-releasing hormone (GnRH) antagonist during luteal phase of patients at high risk for ovarian hyperstimulation syndrome (OHSS). A total of 99 infertile women undergoing in vitro fertilization and embryo transfer or intracytoplasmic sperm injection with high risk for OHSS were enrolled in this randomized controlled trial.The letrozole group (51) received letrozole of 7.5 mg daily for 3 days;the GnRH antagonist group (48) were given cetrorelix of 0.25 mg subcutaneously daily for 3 days. Both groups received support therapy combined with embryo cryopreservation. The incidence of OHSS was surveyed. And the serum concentration of estradiol, LH and progesterone on days 3, 5 and 8 after oocytes retrieval were measured. There were no statistical differences in terms of baseline characteristics of patients and outcomes of controlled ovarian hyperstimulation between the two groups.The incidence of moderate and severe OHSS was found no significantly difference between letrozole group [11.8%(6/51)] and GnRH antagonist group [10.4%(5/48);0.05]. The estradiol concentration of the indicated days on days 3,5 and 8 after oocytes retrieval in letrozole group and GnRH antagonist group were (1 417±3 543) versus (15 210±9 921) pmol/L, (1 692±4 330) versus (18 680±11 567) pmol/L, (239±336) versus (3 582±5 427) pmol/L, respectively;compared with GnRH antagonist group, the estradiol level was significantly lower in the letrozole group (all 0.01). The luteinizing hormone level in the letrozole group were (0.46±0.40), (0.56±0.55)and (0.67±0.58) U/L on days 3,5 and 8 after oocytes retrieval, which were significantly higher than those of GnRH antagonist group [(0.28±0.28), (0.30±0.19) and (0.45±0.37) U/L, respectively; all 0.05]. There was no obvious differences on progesterone levels between letrozole group and GnRH antagonist group (all 0.05),and on days 8 after oocytes retrieval,the level of progesterone in each group were significantly lower than those on day 3 and 5 after oocytes retrieval (0.05). Letrozole has the same efficiency as GnRH antagonist for the prevention of OHSS, faster and cheaper to use, but its efficacy seems not to be related to the suppression of steroidogenic during the luteal phase.
探讨并比较来曲唑与促性腺激素释放激素（GnRH）拮抗剂在卵巢过度刺激综合征（OHSS）高危患者黄体期的预防效果。本随机对照试验共纳入99例接受体外受精-胚胎移植或卵胞浆内单精子注射且有OHSS高危因素的不孕女性。来曲唑组（51例）每天口服来曲唑7.5mg，共3天；GnRH拮抗剂组（48例）每天皮下注射西曲瑞克0.25mg，共3天。两组均接受支持治疗并联合胚胎冷冻保存。观察OHSS的发生率，并测定取卵后第3、5、8天的血清雌二醇、促黄体生成素（LH）和孕酮浓度。两组患者的基线特征及控制性卵巢刺激的结局无统计学差异。来曲唑组中重度OHSS的发生率[11.8%（6/51）]与GnRH拮抗剂组[10.4%（5/48）]相比，差异无统计学意义（P＞0.05）。来曲唑组与GnRH拮抗剂组取卵后第3、5、8天雌二醇浓度分别为（1417±3543）与（15210±9921）pmol/L、（1692±4330）与（18680±11567）pmol/L、（239±336）与（3582±5427）pmol/L；与GnRH拮抗剂组相比，来曲唑组雌二醇水平显著降低（均P＜0.01）。来曲唑组取卵后第3、5、8天LH水平分别为（0.46±0.40）、（0.56±0.55）和（0.67±0.58）U/L，显著高于GnRH拮抗剂组[分别为（0.28±0.28）、（0.30±0.19）和（0.45±0.37）U/L；均P＜0.05]。来曲唑组与GnRH拮抗剂组孕酮水平差异无统计学意义（均P＞0.05），且取卵后第8天，每组孕酮水平均显著低于取卵后第3天和第5天（P＜0.05）。来曲唑在预防OHSS方面与GnRH拮抗剂效果相同，使用更快且费用更低，但它的疗效似乎与黄体期类固醇生成的抑制无关。
