A Randomized Cohort Study: Is It Worth the Time to Receive Antiandrogenic Pretreatment Before Ovulation Induction for Women With Polycystic Ovary Syndrome?

Abstract

ObjectiveTo assess the effect of antiandrogenic pretreatment using combined oral contraceptives (COCs) before ovulation induction in infertile patients with polycystic ovary syndrome (PCOS) with hyperandrogenism.DesignProspective, randomized open-labeled cohort studySettingMulticenterPatientsPCOS patients with hyperandrogenism and requiring infertility treatmentsInterventionsRandomization to direct ovulation induction of letrozole (letrozole group) or ethinylestradiol/cyproterone acetate (EE/CPA) for 3 months and subsequent letrozole-induced ovulation (EE/CPA+ letrozole group). The maximum number of ovulation induction cycle was three to four.Main Outcome MeasuresOvulation rate, conception rate, ongoing pregnancy rate, and live birth rate were the main outcomes of the study.ResultsThere were no significant differences in the cumulative ovulation, conception, ongoing pregnancy, and live birth rates between the letrozole and EE/CPA+ letrozole groups (cumulative ovulation: 206/254 [81.10%] vs. 169/205 [82.44%], risk ratio [RR]= 1.09 [0.68,1.76], P=0.713; conception: 44/90 [48.89%] vs. 42/76 [55.26%], RR= 1.29 [0.70,2.38], P=0.413; ongoing pregnancy: 33/90 [36.67%] vs. 33/76 [43.42%], RR=1.33 [0.71,2.47], P=0.376; and live birth: 32/90 [35.56%] vs. 31/76 [40.79%], RR=1.25 [0.67, 2.34], P=0.489).ConclusionsThe results of this study showed that COC pretreatment was not superior to direct letrozole-induced ovulation therapy in improving ovulation and pregnancy results in women with PCOS. There is no benefit to perform antiandrogenic therapy before ovulation induction in patients with PCOS in clinical practice.Clinical Trial Registrationwww.clinicaltrials.gov, identifier ChiCTR1900022839

Association between preconception anti-androgen therapy and pregnancy outcomes of patients with PCOS: A prospective cohort study

“…The main types of congenital malformations we observed were developmental abnormalities of the nervous system, musculoskeletal system, and urogenital tract system, while other types of developmental abnormalities were not observed in our study. A higher rate of neonatal transfer in PCOS patients compared to the general population has been associated with preterm birth, hypoglycemia, jaundice and respiratory distress syndrome ( 28 ). Although our study found that preconception intervention with DRSP/EE(II) though did not significantly reduce the neonatal transfer rate, there may be a diversity of reasons for neonatal referrals.…”

Role of luteinizing hormone elevation in outcomes of ovulation induction with letrozole for polycystic ovary syndrome

“…Branigan EF et al showed that OI with CC following OC pretreatment yielded higher pregnancy rates for PCOS women resistant to CC (28). In contrast, no significantly better outcome following preintervention with OCs was observed in another clinical trial (29). Recently, OCs, combined with GnRH agonists or antagonists, have been used in IVF programs to prevent a premature LH peak (30-32) and improve reproductive outcomes in PCOS patients (33,34).…”