Letrozole cotreatment improves the follicular output rate in high-body-mass-index women with polycystic ovary syndrome undergoing IVF treatment.
Letrozole cotreatment improves the follicular output rate in high-body-mass-index women with polycystic ovary syndrome undergoing IVF treatment.
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DOI：
10.3389/fendo.2023.1072170
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发表时间：
2023
影响因子：
5.2
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中科院分区：
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患有高体重指数 (BMI) 的多囊卵巢综合征 (PCOS) 的女性通常卵巢反应减弱，卵泡大小减小，这与体外受精 (IVF) 治疗后不良的临床结果有关。卵泡输出率（FORT）是卵泡反应的定性指标，似乎与 IVF 的临床结果呈正相关。孕激素引发的卵巢刺激 (PPOS) 已成为促性腺激素释放激素 (GnRH) 类似物的替代品，可抑制过早黄体生成素 (LH) 激增。由于来曲唑 (LE) 在增强卵巢反应方面表现出良好的前景，因此我们对高 BMI 女性中使用和不使用 LE 的 PPOS 治疗 PCOS 进行了比较，重点关注 FORT 以及相关的临床和妊娠结局。对于招募的1508名女性，包括AFC在内的10个变量；年龄;基础性激素水平；体重指数；不孕症类型；在倾向评分匹配 (PSM) 模型中选择不孕期和之前 IVF 尝试次数，以 1:1 的比例将 1374 名接受 MPA+ hMG 方案的女性与 134 名接受 MPA+ hMG+ LE 治疗的女性进行匹配。 FORT 被选为主要结果指标。取出的卵母细胞数量、存活胚胎、hMG 剂量、持续时间、卵母细胞成熟率、受精率和着床率被确定为次要结果。与 MPA+hMG 组相比，MPA+hMG+LE 组的 FORT 显着升高（61% [35%, 86%] vs. 40% [25%, 60%]，P <.001）。有趣的是，尽管 LE 联合治疗组的成熟卵母细胞和回收胚胎数量相似，但其成熟卵母细胞率却相当低。研究组的平均 hMG 剂量和持续时间与对照组相似。研究组的种植率在数值上高于对照组，但无统计学意义（43.15%（107/248）比38.59%（115/298），OR 1.008，95% CI 0.901-1.127；P >.05）。对于患有 PCOS 和高 BMI 的女性，LE 联合 PPOS 对 FORT 的效果优于标准 PPOS 治疗的效果，但对妊娠结局或 COS 的周期特征（包括 hMG 的消耗）没有实质性有益影响。
Women who have polycystic ovary syndrome (PCOS) with high body mass index (BMI) typically have an attenuated ovarian response and decreased follicular size, which are linked to unfavourable clinical outcomes following in vitro fertilization (IVF) therapy. The follicular output rate (FORT), a qualitative indicator of follicular response, seems to be positively linked to the clinical outcomes of IVF. Progestin-primed ovarian stimulation (PPOS) has become an alternative to gonadotropin-releasing hormone (GnRH) analogues to inhibit the premature luteinizing hormone (LH) surge. As letrozole (LE) shows promise in enhancing ovarian response, we compared PPOS with and without LE for PCOS in high BMI women with a focus on the FORT and associated clinical and pregnancy outcomes. For the recruited 1508 women, ten variables including AFC; age; basal sex hormone level; BMI; infertility type; period of infertility and number of previous IVF attempts were chosen in the propensity score matching (PSM) model to match 1374 women who taken the MPA+ hMG protocol with 134 women who received the MPA+ hMG+ LE treatment at a 1:1 ratio. FORT was selected as the primary outcome measure. The number of oocytes retrieved, viable embryos, hMG dosage, duration, oocyte maturity rate, fertilization rate, and implantation rate were established as secondary outcomes. FORT was substantially elevated in the MPA+hMG+LE group compared with the MPA+hMG group (61% [35%, 86%] vs. 40% [25%, 60%], P <.001). Interestingly, the LE cotreatment group had a considerably lower mature oocyte rate despite having a similar number of mature oocytes and embryos recovered. The average hMG dosages and durations in the study group were similar to those in the control group. The implantation rate in the study group was numerically higher but without statistic significant than that in the control groups (43.15% (107/248) vs. 38.59% (115/298), OR 1.008, 95% CI 0.901-1.127; P >.05). The effect of LE combined with PPOS on FORT is better than the effect of the standard PPOS treatment in women with PCOS and a high BMI, but there is no substantially beneficial impact on pregnancy outcomes or the cycle features of COS, including consumption of hMG.
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影响因子：
--
作者：
Gowri, Vaidyanathan;Al-Amri, Arwa;Almamari, Thikra Mohammed Abdulrahman;Al Khaduri, Maha;Jaju, Sanjay
通讯作者：
Jaju, Sanjay
影响因子：
6.1
作者：
Fedorcsák, P;Dale, PO;Tanbo, T
通讯作者：
Tanbo, T
影响因子：
2.5
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通讯作者：
Smitz, J
影响因子：
3.1
作者：
Kurzawa, Rafal;Ciepiela, Przemyslaw;Brelik, Pawel
通讯作者：
Brelik, Pawel
影响因子：
13.3
作者：
Balen, Adam H.;Morley, Lara C.;Teede, Helena
通讯作者：
Teede, Helena