Effects of Letrozole in Combination with Low-dose Intramuscular Injection of Human Menopausal Gonadotropin on Ovulation and Pregnancy of 156 Patients with Polycystic Ovary Syndrome

Overview

Journal Pak J Med Sci

Specialty General Medicine

Date 2017 Jan 14

PMID 28083040

Citations 9

Authors

Zhihua Chen

Mengzhen Zhang

Yuhuan Qiao

Junjuan Yang

Affiliations

Soon will be listed here.

Abstract

Objective: To explore the effects of letrozole (LE) in combination with low-dose intramuscular injection of human menopausal gonadotropin (HMG) on the ovulation induction and pregnancy of patients with polycystic ovary syndrome (PCOS).

Methods: A total of 156 patients with PCOS infertility were randomly divided into an LE group, a clomiphene citrate (CC) group and an LE + HMG group (n= 52). LE and CC were orally taken according to the prescribed dosage on the 3rd-5th days of menstruation respectively, and 75 IU HMG was given through intramuscular injection. The ovulation induction parameters and pregnancy outcomes were observed.

Results: The number of ovulation cycle of LE + HMG group was significantly higher than that of LE group (χ=8.451, P<0.001). After injection of human chorionic gonadotropin, both endometrial thickness and number of mature follicles of LE + HMG group were significantly higher than those of other two groups (P<0.001), and the daily estradiol (E2) level was also higher (q=4.531, P<0.05). The pregnancy rate of LE + HMG group was 55.7%, which exceeded those of other two groups (compared to LE group, χ=4.012, P<0.05). In LE + HMG group, the average medication cycle of clinically pregnant patients was (2.9 ± 0.3) weeks, which was significantly shorter than those of CC and LE groups (F=17.241, P<0.001).

Conclusion: The regimen using LE in combination with low-dose intramuscular injection of HMG has satisfactory therapeutic effects on ovulation induction, short medication cycle and high clinical pregnancy rate, which is promising for treating patients with PCOS infertility.

Citing Articles

Effects of letrozole alone or in combination with gonadotropins on ovulation induction and clinical pregnancy in women with polycystic ovarian syndrome: a systematic review and meta-analysis of randomized controlled trials.

Baradwan S, Al-Shalhoub F, Alshahrani M, Himayda S, AlSghan R, Sabban H Hormones (Athens). 2024; 23(3):497-508.

PMID: 38280115 DOI: 10.1007/s42000-024-00531-4.

Differential expression of serum mir-363-3p in patients with polycystic ovary syndrome and its predictive value for their pregnancy.

Sang M, Yu Y, Zhou Z, Zhang Y, Chang H BMC Womens Health. 2023; 23(1):264.

PMID: 37189071 PMC: 10186668. DOI: 10.1186/s12905-023-02337-9.

Impact of metformin on the clinical and metabolic parameters of women with polycystic ovary syndrome: a systematic review and meta-analysis of randomised controlled trials.

Abdalla M, Shah N, Deshmukh H, Sahebkar A, Ostlundh L, Al-Rifai R Ther Adv Endocrinol Metab. 2022; 13:20420188221127142.

PMID: 36225721 PMC: 9548689. DOI: 10.1177/20420188221127142.

Aromatase inhibitors (letrozole) for ovulation induction in infertile women with polycystic ovary syndrome.

Franik S, Le Q, Kremer J, Kiesel L, Farquhar C Cochrane Database Syst Rev. 2022; 9:CD010287.

PMID: 36165742 PMC: 9514207. DOI: 10.1002/14651858.CD010287.pub4.

The effect of mildly stimulated cycle versus artificial cycle on pregnancy outcomes in overweight/obese women with PCOS prior to frozen embryo transfer: a retrospective cohort study.

Guan L, Wu H, Wei C, Pang C, Liu D, Yu X BMC Pregnancy Childbirth. 2022; 22(1):394.

PMID: 35525951 PMC: 9080216. DOI: 10.1186/s12884-022-04728-6.

References

Denny L, Bhatla N . Preface for Best Practice and Research Clinical Obstetrics and Gynaecology - issue 29.6. Best Pract Res Clin Obstet Gynaecol. 2015; 29(6):765-6. DOI: 10.1016/j.bpobgyn.2015.06.003. View

Franks S . Polycystic ovary syndrome. N Engl J Med. 1995; 333(13):853-61. DOI: 10.1056/NEJM199509283331307. View

Zahiri Sorouri Z, Sharami S, Tahersima Z, Salamat F . Comparison between Unilateral and Bilateral Ovarian Drilling in Clomiphene Citrate Resistance Polycystic Ovary Syndrome Patients: A Randomized Clinical Trial of Efficacy. Int J Fertil Steril. 2015; 9(1):9-16. PMC: 4410042. DOI: 10.22074/ijfs.2015.4202. View

Budinetz T, Benadiva C, Griffin D, Engmann L, Nulsen J, DiLuigi A . Ovulation rate and cycle characteristics in a subsequent clomiphene citrate cycle after stair-step protocol. Fertil Steril. 2015; 103(3):675-9. DOI: 10.1016/j.fertnstert.2014.12.088. View

. Current world literature. Curr Opin Obstet Gynecol. 2010; 22(6):530-6. DOI: 10.1097/GCO.0b013e328340e116. View

Yin Q, Fischer L, Noethling C, Schaefer W . In vitro-assessment of putative antiprogestin activities of phytochemicals and synthetic UV absorbers in human endometrial Ishikawa cells. Gynecol Endocrinol. 2015; 31(7):578-81. DOI: 10.3109/09513590.2015.1047448. View

Amita M, Takahashi T, Igarashi H, Nagase S . Clomiphene citrate down-regulates estrogen receptor-α through the ubiquitin-proteasome pathway in a human endometrial cancer cell line. Mol Cell Endocrinol. 2016; 428:142-7. DOI: 10.1016/j.mce.2016.03.029. View

Yun B, Chon S, Park J, Seo S, Cho S, Choi Y . Minimal stimulation using gonadotropin combined with clomiphene citrate or letrozole for intrauterine insemination. Yonsei Med J. 2015; 56(2):490-6. PMC: 4329363. DOI: 10.3349/ymj.2015.56.2.490. View

Ghosh D, Lo J, Egbuta C . Recent Progress in the Discovery of Next Generation Inhibitors of Aromatase from the Structure-Function Perspective. J Med Chem. 2015; 59(11):5131-48. PMC: 4915572. DOI: 10.1021/acs.jmedchem.5b01281. View

10.

Xi W, Liu S, Mao H, Yang Y, Xue X, Lu X . Use of letrozole and clomiphene citrate combined with gonadotropins in clomiphene-resistant infertile women with polycystic ovary syndrome: a prospective study. Drug Des Devel Ther. 2015; 9:6001-8. PMC: 4651359. DOI: 10.2147/DDDT.S83259. View

11.

Al-Inany H, Azab H, El-Khayat W, Nada A, El-Khattan E, Abou-Setta A . The effectiveness of clomiphene citrate in LH surge suppression in women undergoing IUI: a randomized controlled trial. Fertil Steril. 2010; 94(6):2167-71. DOI: 10.1016/j.fertnstert.2010.01.069. View

12.

Casper R, Mitwally M . Use of the aromatase inhibitor letrozole for ovulation induction in women with polycystic ovarian syndrome. Clin Obstet Gynecol. 2011; 54(4):685-95. DOI: 10.1097/GRF.0b013e3182353d0f. View

13.

Palihawadana T, Wijesinghe P, Seneviratne H . Factors associated with nonresponse to ovulation induction using letrozole among women with World Health Organization group II anovulation. J Hum Reprod Sci. 2015; 8(2):75-9. PMC: 4477453. DOI: 10.4103/0974-1208.158598. View

14.

Al-Omari W, Sulaiman W, Al-Hadithi N . Comparison of two aromatase inhibitors in women with clomiphene-resistant polycystic ovary syndrome. Int J Gynaecol Obstet. 2004; 85(3):289-91. DOI: 10.1016/j.ijgo.2003.11.010. View

15.

Abdelazim I, Makhlouf H . Sequential clomiphene citrate/hMG versus hMG for ovulation induction in clomiphene citrate-resistant women. Arch Gynecol Obstet. 2012; 287(3):591-7. DOI: 10.1007/s00404-012-2597-7. View

16.

Bacci M, Giannoni E, Fearns A, Ribas R, Gao Q, Taddei M . miR-155 Drives Metabolic Reprogramming of ER+ Breast Cancer Cells Following Long-Term Estrogen Deprivation and Predicts Clinical Response to Aromatase Inhibitors. Cancer Res. 2016; 76(6):1615-26. DOI: 10.1158/0008-5472.CAN-15-2038. View

17.

Ellakwa H, Sanad Z, Hamza H, Emara M, Elsayed M . Predictors of patient responses to ovulation induction with clomiphene citrate in patients with polycystic ovary syndrome experiencing infertility. Int J Gynaecol Obstet. 2016; 133(1):59-63. DOI: 10.1016/j.ijgo.2015.09.008. View

18.

Brown J, Farquhar C, Beck J, Boothroyd C, Hughes E . Clomiphene and anti-oestrogens for ovulation induction in PCOS. Cochrane Database Syst Rev. 2009; (4):CD002249. DOI: 10.1002/14651858.CD002249.pub4. View

19.

Revelli A, Chiado A, Dalmasso P, Stabile V, Evangelista F, Basso G . "Mild" vs. "long" protocol for controlled ovarian hyperstimulation in patients with expected poor ovarian responsiveness undergoing in vitro fertilization (IVF): a large prospective randomized trial. J Assist Reprod Genet. 2014; 31(7):809-15. PMC: 4096882. DOI: 10.1007/s10815-014-0227-y. View