Letrozole cotreatment with progestin-primed ovarian stimulation in women with polycystic ovary syndrome undergoing IVF treatment.
Letrozole cotreatment with progestin-primed ovarian stimulation in women with polycystic ovary syndrome undergoing IVF treatment.
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DOI：
10.3389/fphys.2022.965210
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发表时间：
2022
影响因子：
4
通讯作者：
中科院分区：
文献类型：
--
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背景：孕激素是卵泡期促性腺激素释放激素 (GnRH) 类似物的替代品，可抑制多囊卵巢综合征 (PCOS) 女性的黄体生成素 (LH) 过早激增。然而，孕激素引发的卵巢刺激（PPOS）总是伴随着垂体抑制和促性腺激素消耗的增加。先前的研究表明来曲唑似乎有可能减少卵巢刺激所需的促性腺激素总剂量。一项回顾性队列研究旨在评估 PPOS 联合或不联合来曲唑治疗 PCOS 不孕女性的疗效。 方法：这项回顾性队列研究纳入了 448 名 PCOS 女性，她们在倾向评分匹配后于 2018 年 1 月至 2021 年 3 月接受了人绝经期促性腺激素 (hMG) 和醋酸甲羟孕酮 (MPA) 控制性卵巢刺激 (COS)（n = 224）或 hMG 和 MPA 与 LE 联合治疗（n = 224）。主要结果指标是 hMG 剂量。次要结果是卵巢刺激的持续时间、着床率、取出的卵母细胞和存活胚胎的数量、卵母细胞成熟度和受精率、垂体严重抑制的女性比例（触发日黄体生成素 [LH] <1.0 IU/L）。 结果：两组之间的 hMG 剂量（1949.89 ± 725.03 IU vs 2017.41 ± 653.32 IU，p > 0.05）和卵巢刺激持续时间（9.03 ± 1.79 天 vs 9.21 ± 2.18 天，p > 0.05）相似。研究组（MPA + hMG + LE）的植入率显着高于对照组（MPA + hMG）（42.22 vs 34.69%，p < 0.05）。两组之间取出的卵母细胞和胚胎的数量相似。有趣的是，与标准 PPOS 方案相比，来曲唑联合治疗与卵母细胞成熟度和受精率降低相关，尽管成熟卵母细胞产量和受精卵母细胞产量相当。与对照组相比，研究组在触发日的LH值显着升高，同时垂体抑制显着减轻。 结论：来曲唑联合 PPOS 不能减少接受 IVF 治疗的 PCOS 患者的 hMG 消耗，并且对 COS 的周期特征没有有益影响。然而，补充来曲唑在 PCOS 女性中表现出优于标准 PPOS 方案的着床率。
Background: Progestin is an alternative to gonadotropin-releasing hormone (GnRH) analogues in the follicular phase to suppress the premature luteinizing hormone (LH) surge in women with polycystic ovary syndrome (PCOS). However, progestin-primed ovarian stimulation (PPOS) is always accompanied by increased pituitary suppression and gonadotropin consumption. Previous studies suggested that letrozole appeared to have the potential to reduce the total gonadotropin dose required for ovarian stimulation. A retrospective cohort study was performed to evaluate the efficacy of PPOS with or without letrozole in infertile women with PCOS. Methods: This retrospective cohort study included 448 women with PCOS who underwent controlled ovarian stimulation (COS) with human menopausal gonadotropin (hMG) and medroxyprogesterone acetate (MPA) (n = 224) or hMG and MPA cotreatment with LE (n = 224) from January 2018 to March 2021 after propensity-score matching. The primary outcome measure was the hMG dose. The secondary outcomes were the durations of ovarian stimulation, the implantation rate, the number of oocytes retrieved and viable embryos, oocyte maturity and fertilization rates, the percentage of women with profound pituitary suppression (luteinizing hormone [LH] <1.0 IU/L on the trigger day). Results: The hMG doses (1949.89 ± 725.03 IU vs 2017.41 ± 653.32 IU, p > 0.05) and durations of ovarian stimulation (9.03 ± 1.79 days vs 9.21 ± 2.18 days, p > 0.05) were similar between the two groups. The implantation rate was significantly higher in the study group (MPA + hMG + LE) than in the control group (MPA + hMG) (42.22 vs 34.69%, p < 0.05). The numbers of oocytes and embryos retrieved were similar between the two groups. Interestingly, letrozole cotreatment was associated with decreased oocyte maturity and fertilization rates in comparison with standard PPOS protocols even though mature and fertilized oocyte yields were comparable. Compared with those in the control group, the LH values on the trigger day were significantly higher in the study group, together with significantly reduced pituitary suppression. Conclusion: Letrozole combined with PPOS cannot reduce hMG consumption in PCOS patients undergoing IVF treatment and shows no beneficial effect on cycle characteristics of COS. However, letrozole supplementation manifests as a superior implantation rate to that of the standard PPOS protocol in women with PCOS.
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影响因子：
13.3
作者：
Balen, Adam H.;Morley, Lara C.;Teede, Helena
通讯作者：
Teede, Helena
影响因子：
13.3
作者：
Requena A;Herrero J;Landeras J;Navarro E;Neyro JL;Salvador C;Tur R;Callejo J;Checa MA;Farré M;Espinós JJ;Fábregues F;Graña-Barcia M;Reproductive Endocrinology Interest Group of Spanish Society of Fertility
通讯作者：
Reproductive Endocrinology Interest Group of Spanish Society of Fertility
对接受体外受精/胞浆内单精子注射的正常排卵女性进行孕激素引发的卵巢刺激，并补充或不补充克罗米芬：一项前瞻性随机对照试验
影响因子：
3.2
作者：
Liu, Yali;Chen, Qiuju;Kuang, Yanping
通讯作者：
Kuang, Yanping
影响因子：
4
作者：
Chen C;Yu S;Yu W;Yan Z;Jin W;Si J;Li M;Cai R;Li D;Wang L;Chen Q;Kuang Y;Lyu Q;Long H
通讯作者：
Long H
影响因子：
6.7
作者：
Rosen, Mitchell P.;Shen, Shehua;Cedars, Marcelle I.
通讯作者：
Cedars, Marcelle I.