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首页> 外文期刊>Reproductive Biology and Endocrinology >Mild ovarian stimulation with letrozole plus fixed dose human menopausal gonadotropin prior to IVF/ICSI for infertile non-obese women with polycystic ovarian syndrome being pre-treated with metformin: a pilot study
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Mild ovarian stimulation with letrozole plus fixed dose human menopausal gonadotropin prior to IVF/ICSI for infertile non-obese women with polycystic ovarian syndrome being pre-treated with metformin: a pilot study

机译：试点研究：在IVF / ICSI之前，用来曲唑加固定剂量的更年期促性腺激素对不育的非肥胖多囊卵巢综合征女性进行轻度卵巢刺激：一项先导研究

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Letrozole is widely employed as ovulation induction agent in women with PCOS, but its use in mild stimulation (MS) protocols for IVF is limited. Aim of the present study was to evaluate the feasibility of a MS protocol with letrozole plus hMG in non-obese PCOS women undergoing IVF after a metformin pre-treatment. We retrospectively evaluated the data of 125 non-obese PCOS undergoing MS with letrozole plus hMG, 150?IU as starting dose, (group 1, N?=?80) compared to those undergoing a conventional IVF stimulation protocols (CS) (group 2, N?=?45) prior to IVF. All patients had received metformin extended release 1200–2000?mg daily for three to six months before IVF. GnRH antagonist was administered in both groups when the leading follicles reached 14?mm. Both groups were comparable for age, BMI and ovarian reserve markers. Both groups showed lower than expected AFC and AMH values as a consequence of metformin pre-treatment. Letrozole-treated patients required a significantly lower amount of gonadotropins units (p??0.0001), and showed significantly lower day 5, day 8 and hCG day E2 levels compared to patients undergoing the CS protocol (p??0.0001, p??0.0001 and p?=?0.001 respectively). The oocyte yield, in terms of total (6, IQR 3, vs 6, IQR 4 respectively,) and MII oocytes (5, IQR 3, vs 5, IQR 3, respectively) number, did not differ among groups; the number of total (3, IQR 2, vs 3, IQR 1 respectively) and good quality embryos (2, IQR1 vs 2, IQR 1,5 respectively) obtained was comparable as well in the two groups. The number of fresh transfers was significantly higher in group 1 compared to group 2 (80% vs 60%, p?=?0.016). A trend for higher cumulative clinical pregnancy rate was found in women undergoing MS compared to CS (42.5%vs 24,4%, p?=?0.044), but the study was not powered to detect this difference. The present study suggests that the use of letrozole as adjuvant treatment to MS protocols for IVF may be an effective alternative to CS protocols for non-obese PCOS patients pre-treated with metformin, as it provides comparable IVF outcome without requiring high FSH dose, and avoiding supraphysiological estradiol levels.
机译：来曲唑被广泛用作PCOS妇女的排卵诱导剂，但其在IVF的轻度刺激（MS）方案中的使用受到限制。本研究的目的是评估二甲双胍预处理后接受IVF的非肥胖PCOS妇女接受来曲唑加hMG的MS方案的可行性。我们回顾性评估了125例非肥胖PCOS接受来曲唑加hMG，150？IU作为起始剂量的MS（第1组，N == 80）与接受常规IVF刺激方案（CS）（第2组）的数据，N≥45）。所有患者均在IVF前三至六个月接受了二甲双胍缓释1200-2000mg的治疗。当前卵泡达到14？mm时，两组均使用GnRH拮抗剂。两组的年龄，BMI和卵巢储备指标均相当。两组因二甲双胍预处理而显示出低于预期的AFC和AMH值。与接受CS方案的患者相比，用来曲唑治疗的患者所需的促性腺激素单位量显着降低（p 0.0001），并且在第5天，第8天和hCG第2天的E2水平显着降低（p 0.0001，p？分别＜＜ 0.0001和p ＜＝ 0.001。卵母细胞产量，以总数（分别为6，IQR 3，对6，IQR 4，）和MII卵母细胞（分别为5，IQR 3，对5，IQR 3）而言，在各组之间没有差异。两组的总数（分别为3，IQR 2、3，IQR 1）和优质胚胎（2，IQR1与2，IQR 1,5）的数量也相当。与第2组相比，第1组的新转移次数显着更高（80％比60％，p <= 0.016）。与CS相比，接受MS的女性有更高的累积临床妊娠率的趋势（42.5％vs 24,4％，p？=？0.044），但该研究无力检测这种差异。本研究表明，对于用二甲双胍预处理的非肥胖PCOS患者，使用来曲唑作为MS方案IVF的辅助治疗可能是CS方案的有效替代方案，因为它无需IVS剂量就可提供可比的IVF结果，并且避免超生理雌二醇水平。

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