Letrozole combined with low dose highly purified human menopausal gonadotropin for ovulation induction in clomiphene citrate-resistant infertile women with polycystic ovary syndrome: a prospective study

doi:10.3969/j.issn.1006-7795.2016.04.004

Abstract

Abstract: Objective To evaluate the efficacy, safety and feasibility of letrozole (LTZ) combined with low dose highly purified human menopausal gonadotropin (Hp-HMG) in clomiphene citrate (CC)-resistant infertile women with polycystic ovary syndrome (PCOS). Methods Totally 120 infertile women with PCOS with CC resistance were enrolled for ovulation induction by LTZ combined with low dose Hp-HMG, together with 237 cycles. The primary study endpoints were the clinical pregnancy rate, the ovulation rate and the percentage of monofollicular development. The secondary efficacy endpoints included the number of ovulated follicles, serum level of estradiol and luteinizing hormone (LH) and endometrial thickness on the day of gonadotropin releasing hormone agonist (GnRH-a) triggering. The main safety parameters were the incidence of adverse events, including the early abortion, ovarian hyperstimulation syndrome (OHSS), and multiple pregnancy. Results The rate of cycle ovulation was 96.2% (228/237), the percentage of monofollicular development was 70% (166/237), cycle cancellation rate was 1.3% (3/237) and anovulation rate was 3.8% (9/237); 237 cycles achieved the periodic single pregnancy rate was 32.9% (75/228), the early abortion rate was 5.3% (12/228). Two twin gestation and 1 ectopic pregnancy; In 120 patients, the rate of cumulative clinical pregnancy was 65% (78/120). No severe OHSS, multiple pregnancy, local or systemic side effects were seen. Conclusion Letrozole combined with low dose Hp-HMG maybe an effective and safe choice for reducing hyperstimulation and increasing pregnancy rate for ovulation induction in CC-resistant women with PCOS.

Key words: polycystic ovary syndrome, highly purified human menopausal gonadotropin, letrozole, clomiphene citrate resistance, clinical pregnancy rate

CLC Number:

R711.75

Zhao Yue, Ruan Xiangyan, Li Yanglu, Du Juan, Alfred O. Mueck. Letrozole combined with low dose highly purified human menopausal gonadotropin for ovulation induction in clomiphene citrate-resistant infertile women with polycystic ovary syndrome: a prospective study[J]. Journal of Capital Medical University, 2016, 37(4): 431-436.

0
/ / Recommend

Add to citation manager EndNote|Reference Manager|ProCite|BibTeX|RefWorks

URL: https://journal03.magtech.org.cn/Jweb_sdykdxxb/EN/10.3969/j.issn.1006-7795.2016.04.004

https://journal03.magtech.org.cn/Jweb_sdykdxxb/EN/Y2016/V37/I4/431

References

[1] 赵越, 阮祥燕, 崔亚美, 等.不同亚型的多囊卵巢综合征患者临床及实验室指标特征的研究[J]. 首都医科大学学报, 2015, 36(4): 567-572.
[2] Mitwally F M, Casper R F. Use of an aromatase inhibitor for induction of ovulation in patients with an inadequate response to clomiphene citrate[J]. Fertile Steril, 2001, 75(2): 305-309.
[3] Homburg R, Hendriks M L, König T E, et al. Clomifene citrate or low-dose FSH for the first-line treatment of infertile women with anovulation associated with polycystic ovary syndrome: a prospective randomized multinational study[J]. Human Reprod, 2012, 27(2): 468-473.
[4] Elnashar A, Fouad H, Eldosoky M, et al. Letrozole induction of ovualtion in women with clomiphene citrate-resistant polycystic ovary syndrome may not depend on the period of infertility, the body mass index, or the luteinizing hormone/follicle-stimulating hormone ratio[J]. Fertil Steril, 2006, 85(2): 511-513.
[5] Andersen Nyboe A N, Devroey P, Arce J C. Clinical outcome following stimulation with highly purified hMG or recombinant FSH in patients undergoing IVF: a randomized assessor-blind controlled trial[J]. Human Reprod, 2006, 21(12): 3217-3227.
[6] The Rotterdam ESHER/ASRM-sponseored PCOS Consensus Workshop Group. Revised 2003 consensus of diagnostic criteria and long-term health risks related to polycystic ovary syndrome(PCOS)[J]. Hum Reprod, 2004, 19(1): 41-47.
[7] Xi W, Liu S, Mao H, et al. Use of letrozole and clomiphene citrate combined with gonadotropins in clomiphene-resistant infertile women with polycystic ovary syndrome: a prospective study[J]. Drug Des Devel Ther, 2015, 11(9): 6001-6008.
[8] Boothroyd C, Karia S, Andreadis N, et al. Consensus statement on prevention and detection of ovarian hyperstimulationsyndrome[J].Aust N J Obstet Gynaecol, 2015, 55(6): 523-534.
[9] De Ziegler D, Fraisse T, de Candonlle G, et al. Outlook: Roles of FSH and LH during the follicular phase: insight into natural cycle IVF[J]. Rprod Biomed Online, 2007, 15(5): 507-513.
[10] Zhao Y, Du B, Jiang X, et al.Effects of combining low-dose aspirin with a Chinese patent medicine on follicular blood flow and pregnancy outcome[J]. Mol Med Rep, 2014,10(5): 2372-2376.
[11] Balasch J, Fabregues F. Is luteinizing hormone needed for optimal ovulation induction?[J]. Curr Opin Obstet Hynecol, 2002, 14(3): 265-274.
[12] O'Dea L, O'Brien F, Currie K, et al. Follicular development induced by recombinant luteinizing hormone (LH) and follicle-stimulating hormone (FSH) in anovulatory women with LH and FSH deficiency: evidence of a threshold effect[J]. Curr Med Res Opinm, 2008, 24(10): 2785-2793.
[13] Ziebe S, Lundin K, Janssens R, et al. Influence of ovarian stimulation with HP-hMG or recombinant FSH on embryo quality parameters in patients undergoing IVF[J]. Hum Reprod, 2007, 22(9): 2404-2413.
[14] Moro F, Scarinci E, Palla C, et al. Highly purified hMG versus recombinant FSH plus recombinant LH in intrauterine insemination cycles in women≥35 years: a RCT[J]. Hum Reprod, 2015, 30(1): 179-185.
[15] Foutouch L A, Khattab S, Mohesn L A, et al. Clinical outcome following stimulation with HMG versus highly purified HMG in patients undergong ICSI[J]. Reprod Biomed Online, 2007, 14(2): 145-147.
[16] Weiss NS, Nahuis M, Bayram N, et al. Gonadotrophins for ovulation in women with polycystic ovarian syndrome[J]. Cochrane Database Syst Rev, 2015,9(9):CD010290.
[17] Bu Z, Sun Y. The impact of endometrial thickness on the day of human chrionic gonadotrophin (hCG) administration on ongoing pregnancy rate in patients with different ovarian response[J]. PLoS One, 2015,10(12): e0145703.
[18] Platteau P, Andersen AN, Balen A, et al. Similar ovulation rates, but different follicular development with highly purified menotrophin compared with recombinant FSH in WHO Group Ⅱ anovulatory infertility: a randomized controlled study[J]. Hum Rerpod, 2006, 21(7): 1798-1804.
[19] 刘宝莲,韩宝生,邱忠君,等. 克罗米芬、来曲唑联合醋酸曲普瑞林促排卵在宫腔内人工授精助孕中的效果分析[J]. 中国煤炭工业医学杂志,2015,18(10):1645-1647.
[20] 杨颖,王金敏,彭书苹,等. 多囊卵巢综合征与不孕的诊治进展及个体化治疗疗效的临床研究[J]. 中国煤炭工业医学杂志, 2014,17(10) :1568-1570.