Letrozole-stimulated cycles versus hormone replacement treatment cycles for frozen embryo transfer in women with polycystic ovary syndrome: a prospective randomized controlled trial.

IF 3.2 3区医学 Q2 GENETICS & HEREDITY

Journal of Assisted Reproduction and Genetics Pub Date : 2025-06-01 Epub Date: 2025-05-08 DOI:10.1007/s10815-025-03500-x

Linlin Jiang, Jia Huang, Yanxin Xie, Lin Li, Ping Pan, Ruiyi Zhu, Dongzi Yang, Yu Li

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Abstract

Purpose: This study aimed to compare the pregnancy outcomes of letrozole (LE)-induced ovulation and hormone replacement treatment (HRT) in endometrial preparation for frozen embryo transfer (FET) in women with polycystic ovary syndrome (PCOS).

Methods: A randomized controlled trial involved 200 patients with PCOS from December 2017 to December 2022. Participants, who underwent FET with one or two good-quality blastocysts or cleavage-stage embryos, were randomly assigned to the LE group or HRT group in a 1:1 ratio. The primary outcome was the clinical pregnancy rate. Secondary outcomes included biochemical pregnancy, implantation, ectopic pregnancy, miscarriage, multiple pregnancy, and live birth rates.

Results: The clinical pregnancy rate was 66.0% in the LE group compared to 53.0% in the HRT group (absolute difference, 13.0% [95% CI, - 0.5 to 26.5%]; RR, 1.25 [95% CI, 0.98 to 1.57]; P = 0.061). The biochemical pregnancy rate was higher in the LE group (71.0% vs 57.0%; absolute difference, 14.0% [95% CI, 0.8 to 27.2%]; RR, 1.25 [95% CI, 1.01 to 1.54]; P = 0.039). No significant differences were observed for the other secondary outcomes. The LE group showed higher biochemical pregnancy and live birth rates in the normal weight and normal androgen subgroups. Pregnancy outcomes were similar in the overweight and hyperandrogenic subgroups.

Conclusion: There were no statistically significant differences in clinical pregnancy rates between the LE and HRT cycles for FET in women with PCOS. However, the LE protocol may be a preferable option to HRT for women with normal weight or normal androgen levels.

Clinical trial registration: This study was registered at Chinese Clinical Trial Registry ( http://www.chictr.org.cn/ ; ChiCTR-IOR-17014124).

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来曲唑刺激周期与激素替代治疗周期对多囊卵巢综合征妇女冷冻胚胎移植：一项前瞻性随机对照试验。

目的：本研究旨在比较来曲唑（LE）诱导排卵和激素替代治疗（HRT）在多囊卵巢综合征（PCOS）妇女冷冻胚胎移植（FET）子宫内膜准备中的妊娠结局。方法：一项随机对照试验，纳入2017年12月至2022年12月期间200例PCOS患者。参与者接受了一个或两个高质量囊胚或卵裂期胚胎的FET，按1:1的比例随机分配到LE组或HRT组。主要观察指标为临床妊娠率。次要结局包括生化妊娠、着床、异位妊娠、流产、多胎妊娠和活产率。结果：LE组临床妊娠率为66.0%，HRT组为53.0%(绝对差异为13.0% [95% CI, - 0.5 ~ 26.5%]；RR, 1.25 [95% CI, 0.98 ~ 1.57]；p = 0.061)。LE组生化妊娠率较高(71.0% vs 57.0%；绝对差异为14.0% [95% CI, 0.8 ~ 27.2%]；RR, 1.25 [95% CI, 1.01 ~ 1.54]；p = 0.039)。其他次要结果无显著差异。在正常体重和正常雄激素亚组中，LE组表现出较高的生化妊娠和活产率。超重和高雄激素亚组的妊娠结局相似。结论：PCOS患者FET的LE和HRT周期的临床妊娠率无统计学差异。然而，对于体重正常或雄激素水平正常的女性，LE方案可能是HRT的更好选择。临床试验注册：本研究在中国临床试验注册中心注册(http://www.chictr.org.cn/；chictr - ior - 17014124)。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Assisted Reproduction and Genetics 医学-妇产科学

CiteScore

5.70

自引率

9.70%

发文量

286

审稿时长

1 months

期刊介绍： The Journal of Assisted Reproduction and Genetics publishes cellular, molecular, genetic, and epigenetic discoveries advancing our understanding of the biology and underlying mechanisms from gametogenesis to offspring health. Special emphasis is placed on the practice and evolution of assisted reproduction technologies (ARTs) with reference to the diagnosis and management of diseases affecting fertility. Our goal is to educate our readership in the translation of basic and clinical discoveries made from human or relevant animal models to the safe and efficacious practice of human ARTs. The scientific rigor and ethical standards embraced by the JARG editorial team ensures a broad international base of expertise guiding the marriage of contemporary clinical research paradigms with basic science discovery. JARG publishes original papers, minireviews, case reports, and opinion pieces often combined into special topic issues that will educate clinicians and scientists with interests in the mechanisms of human development that bear on the treatment of infertility and emerging innovations in human ARTs. The guiding principles of male and female reproductive health impacting pre- and post-conceptional viability and developmental potential are emphasized within the purview of human reproductive health in current and future generations of our species. The journal is published in cooperation with the American Society for Reproductive Medicine, an organization of more than 8,000 physicians, researchers, nurses, technicians and other professionals dedicated to advancing knowledge and expertise in reproductive biology.