Department of Obstetrics and Gynecology, Memorial Hospital, Diyarbakır, Turkey.
Department of Obstetrics and Gynecology, Health Sciences University, Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey.
J Obstet Gynaecol Res. 2021 Nov;47(11):3875-3882. doi: 10.1111/jog.14936. Epub 2021 Jul 12.
We sought to compare the efficacy of the letrozole (LTZ) stair-step protocol with clomiphene citrate (CC) stair-step protocol in the management of 150 mg dose of CC-resistant polycystic ovary syndrome (PCOS) patients.
We retrospectively compared a total of 61 patients diagnosed as being resistant to the traditional CC protocol who were subsequently managed using the LTZ stair-step protocol with CC-resistant 56 patients who were treated with CC stair-step protocol. The number of follicles ≥18 mm, endometrial thickness, time to ovulation, clinical pregnancy rates, multiple pregnancy rates, spontaneous abortion rates, live birth rates, and systemic side effects in patients were evaluated.
The mean time to ovulation was significantly shorter in the LTZ stair-step group than the CC stair-step group (17.3 ± 7.7 and 22.4 ± 8.1 days, respectively, p < 0.001). The ovulation rate was significantly higher in patients treated with LTZ stair-step protocol than those treated with the CC stair-step protocol (83.6% and 64.2%, respectively, p = 0.007). The clinical pregnancy rate was higher in the LTZ stair-step than the CC stair-step group (32.7% and 17.8%, respectively, p = 0.015). LTZ stair-step group had a significantly higher live birth rate than that of the CC stair-step group (27.8% and 14.2%, respectively, p = 0.012).
The LTZ stair-step protocol revealed higher ovulation, clinical pregnancy, and live birth rates with a shorter time to achieve ovulation than the CC stair-step protocol. Increment of the dose in the same cycle in both protocols did not cause any additional severe side effects.
我们旨在比较来曲唑（LTZ）阶梯方案与枸橼酸氯米酚（CC）阶梯方案治疗 150mg 剂量 CC 抵抗型多囊卵巢综合征（PCOS）患者的疗效。
我们回顾性比较了总共 61 例被诊断为对传统 CC 方案耐药的患者，随后使用 LTZ 阶梯方案进行治疗，与 56 例对 CC 阶梯方案耐药的患者进行治疗。评估患者的卵泡≥18mm 数、子宫内膜厚度、排卵时间、临床妊娠率、多胎妊娠率、自然流产率、活产率和全身副作用。
LTZ 阶梯组的排卵时间明显短于 CC 阶梯组（分别为 17.3±7.7 和 22.4±8.1 天，p<0.001）。LTZ 阶梯组的排卵率明显高于 CC 阶梯组（分别为 83.6%和 64.2%，p=0.007）。LTZ 阶梯组的临床妊娠率高于 CC 阶梯组（分别为 32.7%和 17.8%，p=0.015）。LTZ 阶梯组的活产率明显高于 CC 阶梯组（分别为 27.8%和 14.2%，p=0.012）。
与 CC 阶梯方案相比，LTZ 阶梯方案显示出更高的排卵率、临床妊娠率和活产率，且排卵时间更短。在两个方案中，同一周期增加剂量不会导致任何额外的严重副作用。
