Role of Luteinizing Hormone Elevation in Outcomes of Ovulation Induction with Letrozole for Polycystic Ovary Syndrome

Overview

Journal Front Med (Lausanne)

Specialty General Medicine

Date 2023 May 5

PMID 37144035

Authors

Wenyan Fu

Yanping Kuang

Affiliations

Soon will be listed here.

Abstract

Introduction: The effect of elevated luteinizing hormone (LH) on the clinical outcomes of ovulation induction (OI) in infertile anovulatory patients with polycystic ovary syndrome (PCOS) remains controversial. This retrospective study included PCOS patients undergoing intrauterine insemination (IUI) following letrozole (LE) stimulation without OC pretreatment.

Materials And Methods: A retrospective cohort analysis was conducted in a single, academic ART center from January 2013 to May 2019. In total, 835 IUI cycles of PCOS patients treated with letrozole were collected for the analysis. Cohorts were separated based on the level of basal LH (bLH) and LH level after letrozole administration (LH) during OI. OI response and reproductive outcomes were evaluated for each cohort.

Results: No adverse effects of dysregulated levels of either bLH or LH on ovulation rate or reproductive outcomes were observed. Furthermore, the cohort of individuals with normal bLH and high LH levels, exclusive of LH surge, exhibited significantly higher rates of clinical pregnancy (30.3% vs. 17.3%, = 0.002) and live birth (24.2% vs. 15.2%, = 0.024) than those with normal bLH and normal LH

Conclusion: These results indicated that high LH levels in PCOS are not solid evidence of poor prognosis of letrozole-induced ovulation, while elevated LH may be a prospective predictor for better OI outcomes. It seems that preinhibition of LH secretion is not needed.

Citing Articles

Pretreatment with oral contraceptive pills in women with PCOS scheduled for IVF: a randomized clinical trial.

Gao J, Mai Q, Zhong Y, Miao B, Chen M, Luo L Hum Reprod Open. 2024; 2024(2):hoae019.

PMID: 39697220 PMC: 11653855. DOI: 10.1093/hropen/hoae019.

Competence of Combined Low Dose of Human Chorionic Gonadotropin (HCG) and Clomiphene Citrate (CC) Versus Continued CC during Ovulation Induction in Women with CC-Resistant Polycystic Ovarian Syndrome: A Randomized Controlled Trial.

Thabet M, Abdelhafez M, Elshamy M, Albahlol I, Fayala E, Wageeh A Medicina (Kaunas). 2024; 60(8).

PMID: 39202581 PMC: 11356540. DOI: 10.3390/medicina60081300.

The comparison between fixed versus degressive doses of medroxyprogesterone acetate combined with letrozole in patients of progestin-primed ovarian stimulation protocol: a propensity score-matched study.

Zhang Y, Li H, Zhu S, Jiang S, Zhao W, Wang X Front Endocrinol (Lausanne). 2023; 14:1295787.

PMID: 38155955 PMC: 10754509. DOI: 10.3389/fendo.2023.1295787.

References

Palomba S, Falbo A, Orio Jr F, Russo T, Tolino A, Zullo F . Pretreatment with oral contraceptives in infertile anovulatory patients with polycystic ovary syndrome who receive gonadotropins for controlled ovarian stimulation. Fertil Steril. 2007; 89(6):1838-42. DOI: 10.1016/j.fertnstert.2007.05.035. View

Ozdemir U, Ozaksit G, Cakir Gungor A, Aydogan M . Letrozole usage adjuvant to gonadotropins for ovulation induction for patients with clomiphene citrate failure. Arch Gynecol Obstet. 2013; 288(2):445-8. DOI: 10.1007/s00404-013-2780-5. View

Sabatini L, Lower A, Wilson C, Al-Shawaf T, Grudzinskas J . Does pretreatment with progestogen or oral contraceptive pills in low responders followed by the GnRHa flare protocol improve the outcome of IVF-ET?. J Assist Reprod Genet. 2000; 17(3):140-6. PMC: 3455662. DOI: 10.1023/a:1009462004650. View

van Santbrink E, Hop W, Fauser B . Classification of normogonadotropic infertility: polycystic ovaries diagnosed by ultrasound versus endocrine characteristics of polycystic ovary syndrome. Fertil Steril. 1997; 67(3):452-8. DOI: 10.1016/s0015-0282(97)80068-4. View

Yildiz B . Approach to the patient: contraception in women with polycystic ovary syndrome. J Clin Endocrinol Metab. 2015; 100(3):794-802. DOI: 10.1210/jc.2014-3196. View

Wei D, Shi Y, Li J, Wang Z, Zhang L, Sun Y . Effect of pretreatment with oral contraceptives and progestins on IVF outcomes in women with polycystic ovary syndrome. Hum Reprod. 2016; 32(2):354-361. PMC: 5870982. DOI: 10.1093/humrep/dew325. View

. Consensus on infertility treatment related to polycystic ovary syndrome. Fertil Steril. 2008; 89(3):505-22. DOI: 10.1016/j.fertnstert.2007.09.041. View

Branigan E, Estes M . A randomized clinical trial of treatment of clomiphene citrate-resistant anovulation with the use of oral contraceptive pill suppression and repeat clomiphene citrate treatment. Am J Obstet Gynecol. 2003; 188(6):1424-8; discussion 1429-30. DOI: 10.1067/mob.2003.459. View

Starosta A, Gordon C, D Hornstein M . Predictive factors for intrauterine insemination outcomes: a review. Fertil Res Pract. 2020; 6(1):23. PMC: 7731622. DOI: 10.1186/s40738-020-00092-1. View

10.

Chen Z, Tan J, Wang H, Zheng B, Liu J, Hao G . A Randomized Cohort Study: Is It Worth the Time to Receive Antiandrogenic Pretreatment Before Ovulation Induction for Women With Polycystic Ovary Syndrome?. Front Endocrinol (Lausanne). 2022; 13:813188. PMC: 8907996. DOI: 10.3389/fendo.2022.813188. View

11.

Legro R, Dodson W, Kris-Etherton P, Kunselman A, Stetter C, Williams N . Randomized Controlled Trial of Preconception Interventions in Infertile Women With Polycystic Ovary Syndrome. J Clin Endocrinol Metab. 2015; 100(11):4048-58. PMC: 4702450. DOI: 10.1210/jc.2015-2778. View

12.

Van Voorhis B, Barnett M, Sparks A, Syrop C, Rosenthal G, Dawson J . Effect of the total motile sperm count on the efficacy and cost-effectiveness of intrauterine insemination and in vitro fertilization. Fertil Steril. 2001; 75(4):661-8. DOI: 10.1016/s0015-0282(00)01783-0. View

13.

Decanter C, Robin G, Thomas P, Leroy M, Lefebvre C, Soudan B . First intention IVF protocol for polycystic ovaries: does oral contraceptive pill pretreatment influence COH outcome?. Reprod Biol Endocrinol. 2013; 11:54. PMC: 3710227. DOI: 10.1186/1477-7827-11-54. View

14.

Escobar-Morreale H . Polycystic ovary syndrome: definition, aetiology, diagnosis and treatment. Nat Rev Endocrinol. 2018; 14(5):270-284. DOI: 10.1038/nrendo.2018.24. View

15.

Laven J, Imani B, Eijkemans M, Fauser B . New approach to polycystic ovary syndrome and other forms of anovulatory infertility. Obstet Gynecol Surv. 2002; 57(11):755-67. DOI: 10.1097/00006254-200211000-00022. View

16.

Rombauts L, Healy D, Norman R . A comparative randomized trial to assess the impact of oral contraceptive pretreatment on follicular growth and hormone profiles in GnRH antagonist-treated patients. Hum Reprod. 2005; 21(1):95-103. DOI: 10.1093/humrep/dei302. View

17.

Cedrin-Durnerin I, Grange-Dujardin D, Laffy A, Parneix I, Massin N, Galey J . Recombinant human LH supplementation during GnRH antagonist administration in IVF/ICSI cycles: a prospective randomized study. Hum Reprod. 2004; 19(9):1979-84. DOI: 10.1093/humrep/deh369. View

18.

Sondheimer S . Oral contraceptives: mechanism of action, dosing, safety, and efficacy. Cutis. 2008; 81(1 Suppl):19-22. View

19.

Conway G, Dewailly D, Diamanti-Kandarakis E, Escobar-Morreale H, Franks S, Gambineri A . The polycystic ovary syndrome: a position statement from the European Society of Endocrinology. Eur J Endocrinol. 2014; 171(4):P1-29. DOI: 10.1530/EJE-14-0253. View

20.

Gordon U, Harrison R, Fawzy M, Hennelly B, Gordon A . A randomized prospective assessor-blind evaluation of luteinizing hormone dosage and in vitro fertilization outcome. Fertil Steril. 2001; 75(2):324-31. DOI: 10.1016/s0015-0282(00)01701-5. View