Comparison of frozen embryo transfer outcomes in hormonal vs. mild stimulation protocols in polycystic ovary syndrome women: A randomized controlled trial.

IF 1.4 Q3 OBSTETRICS & GYNECOLOGY

International Journal of Reproductive Biomedicine Pub Date : 2026-02-14 eCollection Date: 2025-12-01 DOI:10.18502/ijrm.v23i12.20712

Kobra Hamdi, Sahar Khakpour, Aliyeh Ghasemzadeh Darjani, Laya Farzadi, Behrouz Niknafs, Nazli Navali, Parvin Hakimi, Roghayeh Anvari Aliabad, Hamed Hajipour

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Abstract

Background: Polycystic ovary syndrome (PCOS) is a leading cause of anovulatory infertility. In women undergoing frozen embryo transfer, the method of endometrial preparation (hormone replacement therapy [HRT] or mild ovarian stimulation [MOS]) can affect pregnancy outcomes. Letrozole-based MOS protocols may improve endometrial receptivity and reduce miscarriage rates by upregulating key implantation markers leukemia inhibitory factor, dickkopf-related protein 1, leukemia inhibitory factor receptor, fibroblast growth factor 22, integrin alpha V beta 3.

Objective: This study aimed to compare the frozen embryo transfer outcomes in 2 endometrial preparation methods: HRT and MOS in infertile women with PCOS.

Materials and methods: This double-blind randomized trial included 100 infertile women with PCOS and frozen embryos who referred to Al-Zahra hospital, Tabriz, Iran between October 2024 and 2025. Participants were assigned to HRT or MOS for endometrial preparation. In HRT, oral estradiol followed by injectable progesterone was used; in MOS, letrozole +  follicle-stimulating hormone stimulation continued until follicle   $>$  17 mm and endometrium   $\geq$   7.5 mm, then human chorionic gonadotropin was given. Cleavage-stage transfer was performed in both groups, and pregnancy outcomes (chemical, clinical, and final) were compared.

Results: The number of transferred embryos (p = 0.771) and their quality (types 1 and 2) (p = 0.857) were similar between groups. The number of chemical pregnancies in the MOS group (25 cases) was non-significantly higher than in the HRT group (20 cases) (p = 0.078). However, the number of clinical pregnancies (p = 0.045) and the number of successful pregnancies (p = 0.049) were significantly higher in the MOS group compared to the HRT group.

Conclusion: This study showed that MOS achieved higher clinical and successful pregnancy rates than HRT in women with PCOS.

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多囊卵巢综合征妇女激素与轻度刺激冷冻胚胎移植结果的比较：一项随机对照试验。

背景：多囊卵巢综合征（PCOS）是无排卵性不孕的主要原因。在接受冷冻胚胎移植的女性中，子宫内膜准备方法（激素替代疗法[HRT]或轻度卵巢刺激[MOS]）会影响妊娠结局。来曲唑为基础的MOS方案可能通过上调着床关键标志物白血病抑制因子、dickkopf相关蛋白1、白血病抑制因子受体、成纤维细胞生长因子22、整合素α V β 3来改善子宫内膜容受性，降低流产率。目的：比较HRT和MOS两种子宫内膜制备方法在PCOS不孕患者冷冻胚胎移植中的效果。材料和方法：这项双盲随机试验包括100名患有多囊卵巢综合征和冷冻胚胎的不孕妇女，她们于 2024年10月至2025年10月在伊朗大不里士的Al-Zahra医院转诊。参与者被分配到HRT或MOS子宫内膜准备。在HRT中，口服雌二醇后注射黄体酮；MOS组继续给予来曲唑 + 促卵泡激素刺激，直至卵泡 > 17 mm和子宫内膜 ≥ 7.5 mm，再给予人绒毛膜促性腺激素。两组均进行卵裂期转移，并比较妊娠结局（化学、临床和最终）。结果：两组间移植胚胎数量（p = 0.771）和质量（p = 0.857）相近。MOS组化学妊娠数（25例）高于HRT组（20例），差异无统计学意义（p = 0.078）。然而，与HRT组相比，MOS组的临床妊娠次数（p = 0.045）和成功妊娠次数（p = 0.049）显著高于HRT组。结论：在PCOS患者中，MOS比HRT具有更高的临床成功率和成功妊娠率。

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

International Journal of Reproductive Biomedicine OBSTETRICS & GYNECOLOGY-

CiteScore

2.40

自引率

7.70%

发文量

审稿时长

16 weeks

期刊介绍： The International Journal of Reproductive BioMedicine (IJRM), formerly published as "Iranian Journal of Reproductive Medicine (ISSN: 1680-6433)", is an international monthly scientific journal for who treat and investigate problems of infertility and human reproductive disorders. This journal accepts Original Papers, Review Articles, Short Communications, Case Reports, Photo Clinics, and Letters to the Editor in the fields of fertility and infertility, ethical and social issues of assisted reproductive technologies, cellular and molecular biology of reproduction including the development of gametes and early embryos, assisted reproductive technologies in model system and in a clinical environment, reproductive endocrinology, andrology, epidemiology, pathology, genetics, oncology, surgery, psychology, and physiology. Emerging topics including cloning and stem cells are encouraged.