Center for Reproductive Medicine, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.
Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.
Drug Des Devel Ther. 2024 Jul 8;18:2823-2835. doi: 10.2147/DDDT.S458608. eCollection 2024.
Our objective was to investigate the efficacy of letrozole co-treatment in an antagonist protocol for infertile women with polycystic ovary syndrome (PCOS).
This retrospective cohort study included infertile women with PCOS undergoing IVF/ICSI with and without letrozole co-treatment in an antagonist protocol from 2007-2021 at Shanghai Ninth People's Hospital (Shanghai, China). A total of 1559 participants were enrolled, with 1227 women in the antagonist group and 332 women in the letrozole co-treatment group. Propensity score-based patient-matching model was conducted to balance covariates between the groups. The primary outcome was the number of retrieved oocytes, with secondary outcomes including endocrine parameters, ovarian stimulation outcomes, pregnancy outcomes, and obstetrical and neonatal complications.
Letrozole co-treatment induced significant changes in hormonal regulation, increased the percentage of large follicles, and resulted in fewer retrieved oocytes ( < 0.05). However, there was no negative impact on the number of usable embryos or good-quality embryos ( > 0.05). The live birth rates following fresh embryo transfer were comparable between the letrozole and control groups (single embryo transfer: 28.9% vs 29.7%, > 0.05; double embryo transfer: 37.3% vs 45.6%, > 0.05). Additionally, there were no significant differences between the two groups in the live birth rate per patient after frozen embryo transfer and the cumulative live birth rate ( > 0.05). No significant differences in obstetrical and neonatal complications were observed between the groups ( > 0.05).
The addition of letrozole to the antagonist protocol for women with PCOS undergoing IVF induces a higher percentage of large follicles during oocyte retrieval, while reducing the overall number of retrieved oocytes. Moreover, the use of letrozole demonstrates comparable clinical outcomes following embryo transfers. These findings highlight the potential application of letrozole in an antagonist protocol for women with PCOS.
本研究旨在探讨在拮抗剂方案中添加来曲唑对多囊卵巢综合征（PCOS）不孕患者的疗效。
这是一项回顾性队列研究，纳入了 2007 年至 2021 年期间在上海第九人民医院（上海，中国）接受 IVF/ICSI 治疗的 PCOS 不孕患者，分为拮抗剂方案中添加来曲唑（n=332）和未添加来曲唑（n=1227）两组。采用倾向评分匹配模型平衡两组间的协变量。主要结局为获卵数，次要结局包括内分泌参数、卵巢刺激结局、妊娠结局和产科及新生儿并发症。
来曲唑治疗显著改变了激素调节，增加了大卵泡的比例，并导致获卵数减少（<0.05）。然而，这对可利用胚胎和优质胚胎的数量没有负面影响（>0.05）。新鲜胚胎移植后的活产率在来曲唑组和对照组之间相似（单胚胎移植：28.9% vs 29.7%，>0.05；双胚胎移植：37.3% vs 45.6%，>0.05）。此外，冷冻胚胎移植后和累积活产率的患者活产率在两组之间也没有显著差异（>0.05）。两组间的产科和新生儿并发症也没有显著差异（>0.05）。
在接受 IVF 的 PCOS 不孕患者的拮抗剂方案中添加来曲唑会增加取卵时大卵泡的比例，同时减少总的获卵数。此外，使用来曲唑在胚胎移植后具有相似的临床结局。这些发现提示来曲唑在 PCOS 患者拮抗剂方案中的潜在应用。
