Evaluation of effectiveness of Letrozole in treatment of infertility in women with polycystic ovary syndrome

Central Medical College Journal Pub Date : 2024-01-21 DOI:10.3329/cemecj.v7i1.70827

Jasrin Akter Mile, Mashuma Munni, Dilara Rahman, Tahamina Parvin, Shanaz Pervin

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Abstract

Background: Polycystic ovary syndrome (PCOS) is the most common endocrine and metabolic disease, characterized by hyperandrogenism, oligomenorrhea, and polycystic ovaries. PCOS is one of the most causes that affect the women of childbearing age, and often leads to infertility. Various managements were proposed for infertile women with PCOS. However, the optimal management option has not been addressed satisfied. Although multiple treatments including weight reduction, clomiphene citrate, metformin, gonadotropins, and ovary cauterization have been reported to treat such condition, the efficacy still has insufficient evidence to support. Objectives: Purpose of this study was to evaluate the effectiveness of Letrozole in treatment of infertility in women with polycystic ovary syndrome. Materials & method: This study was carried out to assess the effectiveness of letrozole and on pregnancy outcomes including the ovulation induction, pregnancy rate, and endometrial thickness in infertile women with polycystic ovarian syndrome (PCOS). Total 106 infertile PCOS patients were recruited and allocated in two groups, Group-L (received letrozole at 2.5 mg twice daily on the 3rd–5th days of menstrual cycle for 5 consecutive days), Group-G 75 U/d−1 gonadotropin through intramuscular injection for 5 days starting from the third day of menstrual cycle). All patient in both arm completed treatment and follow-up. Patients in both groups were treated up to 5 treatment cycles. During follow up, transvaginalultrasonogram (TVS) was performed to see the details of the follicles and the endometrium. Data was processed and analysed with the help of computer program SPSS and Microsoft excel. Quantitative data expressed as mean and standard deviation and qualitative data as frequency and percentage. Comparison was done by tabulation and graphical presentation in the form of tables, pie chart, graphs, bar diagrams, histogram & charts etc. Result: Mean age of the patient was 26.3 ± 5.7 years in group-L and 25.9 ± 6.1 years in group-G. There were no statistical significant differences between the 2 groups regarding age, body weight, height, body mass index (BMI). Present study results showed that patients who received letrozole exert better outcomes in primary endpoint, including ovulation rate (86.7% in group-L & 62.2% in group-G, P =0.004), endometrial thickness (9.3 ± 1.1 mm in group-L & 8.5 ± 1.1 mm in group-G, P = 0.003) and pregnancy rate (64.1% in group-L & 30.1% in group-G, P =0.005). Abortion rate (till the end of 12th week) and multiple pregnancy rate were higher in group-G, but result were non-significant in between groups. Live birth rate in the letrozole group was higher 29(54.7%) than group-G 14(26.4%), the difference was statistically significant (P < .05). Conclusion: Patients who took Letrozole had significantly higher endometrial thickness than other group. Due to the higher pregnancy rate and lower incidence of abortion or multiple pregnancy, letrozole can be an effective for the treatment of anovulatory subfertility of the PCOS patients. Central Medical College Journal Vol 7 No 1 January 2023 Page: 13-19

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来曲唑治疗多囊卵巢综合征妇女不孕症的效果评估

背景：多囊卵巢综合征（PCOS）是最常见的内分泌和代谢疾病，以雄激素过多、月经过少和多囊卵巢为特征。多囊卵巢综合征是影响育龄妇女的最主要原因之一，通常会导致不孕。针对患有多囊卵巢综合症的不孕妇女，人们提出了各种治疗方法。然而，最佳的治疗方案尚未得到满意的解决。尽管有报道称包括减轻体重、枸橼酸克罗米芬、二甲双胍、促性腺激素和卵巢烧灼术在内的多种治疗方法可用于治疗此类疾病，但其疗效仍缺乏足够的证据支持：本研究旨在评估来曲唑治疗多囊卵巢综合征妇女不孕症的有效性：本研究旨在评估来曲唑对多囊卵巢综合征（PCOS）不孕妇女妊娠结局（包括促排卵、妊娠率和子宫内膜厚度）的有效性。研究共招募了 106 名多囊卵巢综合征不孕症患者，并将其分为两组，L 组（在月经周期的第 3-5 天连续 5 天接受来曲唑治疗，每次 2.5 毫克，每天两次）和 G 组（从月经周期的第三天开始肌肉注射 75 U/d-1 促性腺激素，连续 5 天）。两组患者均完成了治疗和随访。两组患者均接受了最多 5 个治疗周期的治疗。在随访期间，进行了经阴道超声波检查（TVS），以了解卵泡和子宫内膜的详细情况。数据的处理和分析借助了计算机程序 SPSS 和 Microsoft excel。定量数据以平均值和标准差表示，定性数据以频率和百分比表示。通过表格、饼图、曲线图、柱状图、直方图和图表等形式进行比较：结果：L 组患者的平均年龄为 26.3 ± 5.7 岁，G 组患者的平均年龄为 25.9 ± 6.1 岁。两组患者在年龄、体重、身高、体重指数（BMI）方面没有明显统计学差异。目前的研究结果显示，接受来曲唑治疗的患者在主要终点方面取得了更好的结果，包括排卵率（L 组为 86.7%，G 组为 62.2%，P =0.004）、子宫内膜厚度（L 组为 9.3 ± 1.1 mm，G 组为 8.5 ± 1.1 mm，P =0.003）和妊娠率（L 组为 64.1%，G 组为 30.1%，P =0.005）。G组的流产率（至第12周末）和多胎妊娠率较高，但两组间差异无显著性。来曲唑组的活产率为29（54.7%）高于G组的14（26.4%），差异有统计学意义（P < .05）：结论：来曲唑组患者的子宫内膜厚度明显高于其他组。由于来曲唑的妊娠率较高，流产或多胎妊娠的发生率较低，来曲唑可以有效治疗多囊卵巢综合征患者的无排卵性不孕症。中央医学院学报》第 7 卷第 1 期，2023 年 1 月，第 13-19 页：13-19

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Central Medical College Journal

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