Evaluation of The Effect of Letrozole in the Ovarian Hyperstimulation Syndrome Prevention in Participants at Risk of Treatment with Ovulation-Stimulating Drugs: A Randomized Controlled Trial

Tehrani, Hatav Ghasemi; Aasasi, Keihaneh; Mardanian, Farahnaz; Mehrabian, Ferdous; Movahedi, Minoo; Naghshineh, Elham

doi:10.52547/rbmb.11.3.386

Cited by 4 publications

(2 citation statements)

References 26 publications

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“…Administrating letrozole in the follicular phase did not effectively reduce OHSS incidence (18). However, an RCT demonstrated that using letrozole for 5 days in the early follicular phase of A GnRH antagonist protocol led to a significant reduction of OHSS (21).…”

Section: Discussionmentioning

confidence: 99%

Letrozole and ovarian hyperstimulation syndrome: Retrospective cross-sectional study

Nikfarjam,

Eftekhar,

Fatehi

et al. 2024

IJRM

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Background: Recently, letrozole has been used to prevent moderate to severe ovarian hyperstimulation syndrome (OHSS) in assisted reproductive technology cycles due to its estrogen-reducing and androgen-increasing effects on the ovaries, affecting granulosa cells, and reducing vascular endothelial growth factor production. Objective: This study aimed to investigate the impact of letrozole consumption in preventing OHSS in infertile women with polycystic ovarian syndrome undergoing in vitro fertilization. Materials and Methods: In this cross-sectional study, among 1743 medical records of infertile women who were scheduled for oocyte retrieval at Research and Clinical Center for Infertility, Yazd, Iran. Data of 343 women with polycystic ovarian syndrome diagnosis and at risk of OHSS was extracted from March 2022–2023. The stimulation was carried out using a flexible gonadotropin releasing hormone (GnRH) antagonist protocol. Women were divided into 2 groups based on whether they received letrozole or not. In the letrozole group, 2.5 mg letrozole twice daily was continued from the trigger day, while in the control group, women did not receive letrozole. The parameters of OHSS severity, hospitalization rates, and the need for albumin prescription were analyzed. Results: 89 women in the letrozole and 254 women in the control group were examined. There was no statistically significant difference between groups in terms of age and body mass index; however, anti-Mullerian hormone was significantly higher than control group (7.53 ± 4.61 vs. 5.47 ± 3.63, p < 0.001). The parameters of OHSS severity, hospitalization rates, and the need for albumin prescription showed no significant differences between the groups. Conclusion: Recent study indicates that incorporating letrozole into the treatment of GnRH antagonists and cabergoline does not reduce the OHSS severity. Key words: Letrozole, Polycystic ovary syndrome, Ovarian hyperstimulation syndrome, Assisted reproductive technologies.

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Section: Discussionmentioning

confidence: 99%

Letrozole and ovarian hyperstimulation syndrome: Retrospective cross-sectional study

Nikfarjam,

Eftekhar,

Fatehi

et al. 2024

IJRM

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“…Fortunately, there are several novel treatments for the management of PCOS that are demonstrating their potential in preclinical animal models and early clinical trials. [43][44][45] 6.2 New treatments targeting excess androgens.…”

Section: Novel Treatments For Pcosmentioning

confidence: 99%

Relationship between Polycystic Ovary Syndrome and Metabolic Syndrome

Cerón

2023

TJOR

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Polycystic ovary syndrome (PCOS) is a heterogeneous, complex, and widely misunderstood endocrine disorder that affects intermediate metabolism, the cardiovascular and reproductive systems, and has social and psychological consequences. The prevalence and incidence of PCOS is high among women with Metabolic Syndrome (MetS). In Mexico, the hyperandrogenic subtype is the most prevalent of the characterized subtypes and is characterized by hyperandrogenism, insulin resistance, and ovulatory dysfunction. Central obesity plays a role in the development of the hyperandrogenic subtype as adipositopathy can cause a syndrome of insulin resistance and androgen excess, both of which contribute to cardiovascular comorbidities. These two syndromes share similar pathophysiological mechanisms, suggesting that PCOS could be a complication of MetS or vice versa. The purpose of this article is to explore the relationship between MetS and PCOS, with a focus on pathogenesis, infertility, microbiota, comorbidities, and treatment.

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Effect of aromatase inhibitors for preventing ovarian hyperstimulation syndrome in infertile patients undergoing in vitro fertilization: a systematic review and meta-analysis

Jiang,

Qiu,

et al. 2024

Reprod Biol Endocrinol

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Purpose To summarize the findings of relevant randomized controlled trials (RCTs) and conduct a meta-analysis to investigate the potential effect of aromatase inhibitors on preventing moderate to severe ovarian hyperstimulation syndrome (OHSS) in infertile women undergoing in vitro fertilization (IVF). Methods We searched for relevant RCTs in electronic databases, including MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and ClinicalTrials.gov (from inception to August 2023). In addition, we manually searched the related reviews and reference lists of included studies for further relevant studies. We included RCTs where aromatase inhibitors prescribed either during controlled ovarian stimulation (COS) or in early luteal phase. The meta-analysis was performed using RevMan 5.4.1 software. The primary outcome was the incidence of moderate to severe OHSS. A descriptive analysis was conducted in cases where a meta-analysis was not feasible due to heterogeneity or lack of comparable data. Results 2858 records were retrieved and 12 RCTs were finally included. Letrozole was administered in the treatment group during COS in seven RCTs, whereas in the early luteal phase in five RCTs. Compared with the control group, the risk of moderate to severe OHSS significantly reduced by 55% in the letrozole group (RR 0.45, 95% CI 0.32 to 0.64, I2 = 0%, 5 RCTs, 494 patients). Moreover, serum estradiol (E2) levels on hCG trigger day significantly decreased with the administration of letrozole during COS (MD -847.23, 95% CI -1398.00 to -296.47, I2 = 93%, 5 RCTs, 374 patients). And serum E2 levels on the 4th, 5th and 7th to 10th day after hCG trigger were also significantly lower than those in the control group when letrozole was administered in the early luteal phase. Conclusions Patients with high risk of OHSS probably benefit from letrozole, which has been revealed to reduce the incidence of moderate to severe OHSS by this systematic review. However, the very limited number of participants and the quality of the included studies does not allow to recommend letrozole for the prevention of severe OHSS.

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Evaluation of The Effect of Letrozole in the Ovarian Hyperstimulation Syndrome Prevention in Participants at Risk of Treatment with Ovulation-Stimulating Drugs: A Randomized Controlled Trial

Cited by 4 publications

References 26 publications

Letrozole and ovarian hyperstimulation syndrome: Retrospective cross-sectional study

Letrozole and ovarian hyperstimulation syndrome: Retrospective cross-sectional study

Relationship between Polycystic Ovary Syndrome and Metabolic Syndrome

Effect of aromatase inhibitors for preventing ovarian hyperstimulation syndrome in infertile patients undergoing in vitro fertilization: a systematic review and meta-analysis

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