Clinical effect of increasing letrozole regimen on ovulation induction in polycystic ovarysyndrome patients
Zhang Jiao, Tan YouHui, Gao Jing
1. Department of Reproductive Medicine, Qingdao Municipal Hospital,Shandong, Qingdao 266001, China; 2. Center of Reproductive Medicine, Affiliated Hospital of QingdaoUniversity, Shandong, Qingdao 266001, China)
Abstract: 【Abstract】 Objective To observe the clinical effect of letrozole increasing regimen on ovulation induction in patients with polycystic ovary syndrome (PCOS) with different body mass index (BMI). Method 202 PCOS patients with routine dose letrozole induced ovulation failure in Department of Reproductive Medicine Qingdao Municipal Hospital from February 2018 to August 2021 were selected as the research subjects. All subjects were divided into BMI≤25 kg/m2 and 25 kg/m2different BMI stratification, they were divided into the observation group and the control group according to the random number table method. Patients in the observation group were treated with letrozole increasing regimen,while patients in the control group were treated with regular letrozole and human menopausal gonadotrophin (HMG)addition regimen. t test, Mann-Whitney U test or χ2 test were used to compare estrogen and HMG medication,follicle growth and cycle outcome between the two groups during ovulation induction. Result In patients withBMI≤25 kg/m2, the days of estrogen supplementation in the observation group and the control group were [(2(0, 3) and 1 (0, 3) d, Z=2.077, P=0.038], the total amount of estrogen was [3 (0, 9) and 3 (0, 10) mg, Z=2.111,P=0.035], respectively; in patients with 25 kg/m2 observation group and the control group were [3 (0, 4) and 2 (0, 4) d, Z=2.656, P=0.008], the total amount ofestrogen was [6 (0, 10) and 3 (0, 11) mg, Z=2.982, P=0.003], respectively; the observation group was largerthan the control group, and the differences were statistically significant. In patients with BMI≤25 kg/m2, thedays of HMG supplementation in the observation group and the control group were [1 (0, 3) and 4 (3, 5) d,Z=3.222, P=0.001], the total amount of HMG was [75 (0, 150) and 225 (225, 300) U, Z=4.626, P<0.001],respectively; in patients with 25 kg/m2and the control group were [2 (1, 4) and 5 (3, 6) d, Z=3.145, P=0.002], the total amount of HMG was [150(75, 225) and 375 (225, 450) U, Z=4.865, P<0.001]; the data of observation group were lower than those ofcontrol group, and the differences were statistically significant. In patients with 25 kg/m2number of HMG days in the observation group and the control group were [2 (1, 4) and 5 (3, 6) d, Z=3.145,P=0.002], the total amount of HMG was [150 (75, 225) and 375 (225, 450) U, Z=4.865, P<0.001]; the dataof observation group were lower than those of control group, and the differences were statistically significant.Among the patients with 25 kg/m2than that in the control group [5 (3, 6) vs 6 (4, 7) times, Z=1.993, P=0.046], and the difference was statisticallysignificant. In patients with BMI≤25 kg/m2, the proportion of 2-3 follicles developing in the observationgroup and the control group was [4.4% (3/68) and 17.0% (10/65), respectively, χ2=5.404, P=0.020]; in patientswith 25 kg/m2χ2=5.297, P=0.021]; the data of observation group were lower than those of control group, and the differences were statistically significant. Among patients with different BMI, there were no significant differences in follicle growthdays, follicular luteinization incidence, intimal thickness on human chorionic gonadotropin (hCG) day, biochemicalpregnancy rate, clinical pregnancy rate, twin pregnancy rate, and early abortion rate between the observation groupand the control group (all P>0.05). Conclusion In PCOS patients with different BMI after routine doseletrozole induced ovulation failure, increasing letrozole has a similar cycle outcome as adding HMG, but itcan reduce the dosage of HMG and the proportion of multiple follicles development, especially in patientswith higher BMI, which can reduce the number of hospitalizes.
2023, Vol. 11 
