Department of the Fourth Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China.
Department of Obstetrics and Gynecology, Hangzhou Women's Hospital (Hangzhou Maternity and Child Health Care Hospital), Hangzhou, Zhejiang, China.
Front Endocrinol (Lausanne). 2022 Nov 24;13:1059609. doi: 10.3389/fendo.2022.1059609. eCollection 2022.
To investigate the efficacy of oral letrozole (LE) starting on day 3 or 5 of the menstrual cycle in patients with polycystic ovary syndrome (PCOS).
Retrospective cohort study.
Reproductive Endocrinology Department of Hangzhou Women's Hospital.
In this retrospective analysis, we analyzed patients who received oral LE for ovulation induction (OI) at the Hangzhou Women's Hospital from January 2016 to January 2021. In total, 539 PCOS patients with fertility requirements were classified into the D3 group and D5 group according to the different starting times of oral LE, that is, from the 3rd or 5th day of the menstrual cycle or LE is taken orally for 5 days starting on day 3 or 5 of progesterone withdrawal bleeding. Treatment started with one tablet (LE 2.5 mg), continue the regimen from the previous cycle in non-responders and continued until pregnancy or for up to three ovulatory cycles, with visits to determine ovulation and pregnancy, followed by tracking of pregnancies. The primary outcome was to compare ovulation rates, conception rates, live birth rates, pregnancy complications, and pregnancy outcomes at different initiation times.
Women who started LE on the 5th day of their menstrual cycle had more cumulative conception rates than those who started LE on the 3rd day(173 of 228[75.9%]. 201 of 311[64.6%], P= 0.005; rate ratio for conception, 1.174; 95% confidence interval,1.052 to 1.311) without significant differences in overall live birth rate, though there were 142 of 228[62.3%] in the D5 group versus 172 of 311[55.3%] in the D3 group (P= 0.105). The median (IQR) endometrial thickness was significantly (P = 0.013) greater during the D5 group treatment compared to the D3 group, which may be related to higher conception and clinical pregnancy rates. The median (IQR) maximum follicle diameter was not statistically (P = 0.073) different between the two groups. The cumulative ovulation per cycle rate was higher with D5 than with D3 (287 of 405 treatment cycles [70.9%] . 388 of 640 treatment cycles [60.6%], P=0.001). There were no significant between-group differences in pregnancy loss (31 of 173 conceptions in the D5 group [17.9%] and 29 of 201 conceptions in the D3 group [14.4%]) or multiples pregnancy (8.2% and 10.5%, respectively). Rates of other adverse events during pregnancy were similar in the two treatment groups.
As compared with D3 group, D5 group was associated with higher ovulation and conception rates, shorter time-to-pregnancy among infertile women with the PCOS.
探讨多囊卵巢综合征（PCOS）患者在月经周期第 3 天或第 5 天开始口服来曲唑（LE）的疗效。
回顾性队列研究。
杭州市妇产科医院生殖内分泌科。
本回顾性分析纳入了 2016 年 1 月至 2021 年 1 月在杭州市妇产科医院接受来曲唑诱导排卵（OI）的 PCOS 患者。共纳入 539 例有生育要求的 PCOS 患者，根据口服 LE 的起始时间不同，分为 D3 组和 D5 组，即从月经周期的第 3 天或第 5 天开始或在孕激素撤退性出血的第 3 天或第 5 天开始口服 LE 5 天。治疗起始剂量为 1 片（LE 2.5mg），未应答者在前一周期的基础上继续治疗，直至妊娠或最多进行 3 个排卵周期，定期随访以确定排卵和妊娠情况，随后对妊娠情况进行跟踪。主要结局为比较不同起始时间的排卵率、妊娠率、活产率、妊娠并发症和妊娠结局。
与月经周期第 3 天开始 LE 相比，月经周期第 5 天开始 LE 的患者累积妊娠率更高（173/228[75.9%]比 201/311[64.6%]，P=0.005；妊娠率比值为 1.174；95%置信区间为 1.052 至 1.311），但总体活产率无显著差异，D5 组为 142/228[62.3%]，D3 组为 172/311[55.3%]（P=0.105）。D5 组治疗期间的子宫内膜厚度中位数（IQR）明显更高（P=0.013），这可能与较高的妊娠和临床妊娠率有关。两组间最大卵泡直径中位数（IQR）无统计学差异（P=0.073）。与 D3 组相比，D5 组的每周期排卵率更高（D5 组 287/405 个治疗周期[70.9%]比 D3 组 388/640 个治疗周期[60.6%]，P=0.001）。D5 组和 D3 组的妊娠丢失率（D5 组 173 例妊娠中的 31 例[17.9%]和 D3 组 201 例妊娠中的 29 例[14.4%]）或多胎妊娠率（分别为 8.2%和 10.5%）均无显著差异。两组妊娠期间其他不良事件的发生率相似。
与 D3 组相比，D5 组可提高排卵率和妊娠率，缩短不孕 PCOS 患者的妊娠时间。
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