Progestin‐primed ovarian stimulation protocol with or without letrozole for patients with normal ovarian reserve: a retrospective cohort study

Jiang, Xing; Jiang, Shengfang; Diao, Honglu; Deng, Kai; Zhang, Changjun

doi:10.1111/jcpt.13567

Cited by 6 publications

(9 citation statements)

References 17 publications

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“…Interestingly, letrozole cotreatment was associated with decreased oocyte maturity and fertilization rates in comparison with standard PPOS protocols even though mature and fertilized oocyte yields were comparable. Previous investigations of letrozole coadministration reported conflicting results on oocyte maturity rate and fertilization rate (Oktay et al, 2006;Quinn et al, 2017;Jiang et al, 2022). Our findings are in accordance with the study published by Quinn et al (Quinn et al, 2017) reporting that letrozole use was associated with a decreased maturity rate compared to the standard GnRH antagonist protocol in breast cancer patients and compared to those undergoing fertility preservation.…”

Section: Discussionsupporting

confidence: 86%

“…Currently, letrozole is widely used as an adjunct for IVF cycles (Yang et al, 2021). Cotreatment with letrozole during ovarian stimulation for IVF could significantly reduce gonadotropin consumption in normal and poor ovarian responders without decreasing the number of retrieved oocytes, some even accompanied by increased pregnancy outcomes, while few studies have focused on the clinical characteristics of letrozole coadministration in PCOS patients treated for IVF (Bulow et al, 2022;Jiang et al, 2022). The endocrine and ovulation induction characteristics of PCOS patients are different from those of normal and poor ovarian responders.…”

Section: Introductionmentioning

confidence: 99%

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Letrozole cotreatment with progestin-primed ovarian stimulation in women with polycystic ovary syndrome undergoing IVF treatment

et al. 2022

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Background: Progestin is an alternative to gonadotropin-releasing hormone (GnRH) analogues in the follicular phase to suppress the premature luteinizing hormone (LH) surge in women with polycystic ovary syndrome (PCOS). However, progestin-primed ovarian stimulation (PPOS) is always accompanied by increased pituitary suppression and gonadotropin consumption. Previous studies suggested that letrozole appeared to have the potential to reduce the total gonadotropin dose required for ovarian stimulation. A retrospective cohort study was performed to evaluate the efficacy of PPOS with or without letrozole in infertile women with PCOS.Methods: This retrospective cohort study included 448 women with PCOS who underwent controlled ovarian stimulation (COS) with human menopausal gonadotropin (hMG) and medroxyprogesterone acetate (MPA) (n = 224) or hMG and MPA cotreatment with LE (n = 224) from January 2018 to March 2021 after propensity-score matching. The primary outcome measure was the hMG dose. The secondary outcomes were the durations of ovarian stimulation, the implantation rate, the number of oocytes retrieved and viable embryos, oocyte maturity and fertilization rates, the percentage of women with profound pituitary suppression (luteinizing hormone [LH] <1.0 IU/L on the trigger day).Results: The hMG doses (1949.89 ± 725.03 IU vs 2017.41 ± 653.32 IU,p > 0.05) and durations of ovarian stimulation (9.03 ± 1.79 days vs 9.21 ± 2.18 days,p > 0.05) were similar between the two groups. The implantation rate was significantly higher in the study group (MPA + hMG + LE) than in the control group (MPA + hMG) (42.22 vs 34.69%, p < 0.05). The numbers of oocytes and embryos retrieved were similar between the two groups. Interestingly, letrozole cotreatment was associated with decreased oocyte maturity and fertilization rates in comparison with standard PPOS protocols even though mature and fertilized oocyte yields were comparable. Compared with those in the control group, the LH values on the trigger day were significantly higher in the study group, together with significantly reduced pituitary suppression.Conclusion: Letrozole combined with PPOS cannot reduce hMG consumption in PCOS patients undergoing IVF treatment and shows no beneficial effect on cycle characteristics of COS. However, letrozole supplementation manifests as a superior implantation rate to that of the standard PPOS protocol in women with PCOS.

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Section: Discussionsupporting

confidence: 86%

Section: Introductionmentioning

confidence: 99%

Letrozole cotreatment with progestin-primed ovarian stimulation in women with polycystic ovary syndrome undergoing IVF treatment

et al. 2022

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“…In addition, the number of oocytes obtained, the number of fertilized oocytes, and the number of available embryos in the Le PPOS group were superior to the traditional PPOS. Previously, Jiang et al 21 reported that Le PPOS could not improve pregnancy outcomes, which was inconsistent with the results of this study. In our study, PSM was used to exclude the difference in outcomes between the two groups caused by the imbalance of factors such as AMH, so it was more reliable.…”

Section: Discussioncontrasting

confidence: 99%

Letrozole cotreatment progestin‐primed ovarian stimulation in women undergoing controlled ovarian stimulation for in vitro fertilization

Wang,

Zhang,

Diao

et al. 2024

J of Obstet and Gynaecol

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AimTo investigate the impact of letrozole cotreatment progestin‐primed ovarian stimulation (PPOS) (Le PPOS) in controlled ovarian stimulation (COS) and the pregnancy outcomes in frozen–thawed embryo transfer cycles.MethodsThis retrospective cohort study included women who underwent in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI). A total of 2575 cycles were included (1675 in the Le PPOS group and 900 in the PPOS group). The primary outcome was the clinical pregnancy rates. The secondary outcome was the live birth rates.ResultsIn this study, propensity score matching (PSM) was performed to create a perfect match of 379 patients in each group. After matching, the numbers of oocytes retrieved, mature oocytes, fertilization, and clinical pregnancy rates were more favorable in the Le PPOS group than in the PPOS group (all p < 0.05). The multivariable analysis showed that the clinical pregnancy rate was higher in the Le PPOS than in the PPOS group (odds ratio = 1.46, 95% confidence interval: 1.05–2.04, p = 0.024) after adjusting for potentially confounding factors (age, anti‐Müllerian hormone levels, antral follicular count, the type of embryo transferred, number of transferred embryos, body mass index, and follicular stimulating hormone and estradiol levels on starting day).ConclusionsThis retrospective study with a limited sample size suggests that the Le PPOS protocol might be an alternative to the PPOS protocol in women undergoing COS and could lead to better pregnancy outcomes. The results should be confirmed using a formal randomized controlled trial.

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“…Notably, oocyte maturity rates were significantly decreased in the LE cotreatment group compared with the PPOS-only group, although mature oocyte yields were comparable. The influence of LE on oocyte maturity remains controversial in the literature (31)(32)(33). LE, an aromatase inhibitor, is usually used in patients who need fertility preservation, such as those with breast cancer, to reduce oestrogen levels (33).…”

Section: Discussionmentioning

confidence: 99%

Letrozole cotreatment improves the follicular output rate in high-body-mass-index women with polycystic ovary syndrome undergoing IVF treatment

Liu

Lin²,

Shen³

et al. 2023

Front. Endocrinol.

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BackgroundWomen who have polycystic ovary syndrome (PCOS) with high body mass index (BMI) typically have an attenuated ovarian response and decreased follicular size, which are linked to unfavourable clinical outcomes following in vitro fertilization (IVF) therapy. The follicular output rate (FORT), a qualitative indicator of follicular response, seems to be positively linked to the clinical outcomes of IVF. Progestin-primed ovarian stimulation (PPOS) has become an alternative to gonadotropin-releasing hormone (GnRH) analogues to inhibit the premature luteinizing hormone (LH) surge. As letrozole (LE) shows promise in enhancing ovarian response, we compared PPOS with and without LE for PCOS in high BMI women with a focus on the FORT and associated clinical and pregnancy outcomes.MethodsFor the recruited 1508 women, ten variables including AFC; age; basal sex hormone level; BMI; infertility type; period of infertility and number of previous IVF attempts were chosen in the propensity score matching (PSM) model to match 1374 women who taken the MPA+ hMG protocol with 134 women who received the MPA+ hMG+ LE treatment at a 1:1 ratio. FORT was selected as the primary outcome measure. The number of oocytes retrieved, viable embryos, hMG dosage, duration, oocyte maturity rate, fertilization rate, and implantation rate were established as secondary outcomes.ResultsFORT was substantially elevated in the MPA+hMG+LE group compared with the MPA+hMG group (61% [35%, 86%] vs. 40% [25%, 60%], P <.001). Interestingly, the LE cotreatment group had a considerably lower mature oocyte rate despite having a similar number of mature oocytes and embryos recovered. The average hMG dosages and durations in the study group were similar to those in the control group. The implantation rate in the study group was numerically higher but without statistic significant than that in the control groups (43.15% (107/248) vs. 38.59% (115/298), OR 1.008, 95% CI 0.901-1.127; P >.05).ConclusionThe effect of LE combined with PPOS on FORT is better than the effect of the standard PPOS treatment in women with PCOS and a high BMI, but there is no substantially beneficial impact on pregnancy outcomes or the cycle features of COS, including consumption of hMG.

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Progestin‐primed ovarian stimulation protocol with or without letrozole for patients with normal ovarian reserve: a retrospective cohort study

Cited by 6 publications

References 17 publications

Letrozole cotreatment with progestin-primed ovarian stimulation in women with polycystic ovary syndrome undergoing IVF treatment

Letrozole cotreatment with progestin-primed ovarian stimulation in women with polycystic ovary syndrome undergoing IVF treatment

Letrozole cotreatment progestin‐primed ovarian stimulation in women undergoing controlled ovarian stimulation for in vitro fertilization

Letrozole cotreatment improves the follicular output rate in high-body-mass-index women with polycystic ovary syndrome undergoing IVF treatment

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