Volume 11, Issue 3 (Vol.11 No.3 Oct 2022)                   rbmb.net 2022, 11(3): 386-393 | Back to browse issues page


XML Print


Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:

Ghasemi Tehrani H, Aasasi K, Mardanian F, Mehrabian F, Movahedi M, Naghshineh E. Evaluation of The Effect of Letrozole in the Ovarian Hyperstimulation Syndrome Prevention in Participants at Risk of Treatment with Ovulation-Stimulating Drugs: A Randomized Controlled Trial. rbmb.net 2022; 11 (3) :386-393
URL: http://rbmb.net/article-1-918-en.html
Department of Obstetrics and Gynecology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
Abstract:   (2745 Views)
Background: This study aims to evaluate the effect of Letrozole (LE) in reducing ovarian hyperstimulation syndrome (OHSS) in high-risk participants with polycystic ovary syndrome (PCOS) treated with In vitro fertilization (IVF).
 
Methods: This study was a randomized clinical trial in which participants were randomly divided into two groups (n= 25 per group). Based on GnRH-antagonist protocol, recombinant follicle stimulating hormone 150 units/day subcutaneously and human menopausal gonadotropin 75 units/day intramuscularly used from day 2 of the menstrual cycle. In the study group, Letrozole 5 mg daily was added simultaneously with gonadotropin during the first five days of the IVF cycle and in the control group placebo was added.
 
Results: There were statistically significant differences among the groups in terms of Estradiol level on Trigger Day (p= 0.04). The total days of stimulation and cumulative Gonadotropin dose were significantly lower in the Letrozole group (p= 0.00). There were no significant differences between the groups in terms of the number of oocytes retrieved, numbers of implanted embryos, and clinical
pregnancy rates (p-value> 0.05). There was only one moderate case in the intervention group and 9 moderate symptoms in the control group (p= 0.04).
 
Conclusions:Administration of Letrozole with GnRH antagonist protocol, conventional protocol in PCOS cases in IVF cycle, had a significant effect on reducing the incidence of OHSS. So, if the future studies prove LE co-administration may lessen the incidence of OHSS, LE will be a highly potent drug for preventing OHSS in PCOS cases.
Full-Text [PDF 234 kb]   (1562 Downloads)    
Type of Article: Original Article | Subject: Biochemistry
Received: 2022/04/15 | Accepted: 2022/05/7 | Published: 2022/12/31

References
1. Akbari Nasrekani Z, Fathi M. Efficacy of 12 weeks aerobic training on body composition, aerobic power and some women-hormones in polycystic ovary syndrome infertile women. Iran J Obstet Gynecol Infertil. 2016;19(5):1-10.
2. Nasseh A, Sarvaideo J. Polycystic Ovary Syndrome. In: Tilstra SA, Kwolek D, Mitchell JL, Dolan BM, Carson MP. (eds) Sex- and Gender-Based Women's Health. Springer, Cham. 2020:83-98 [DOI:10.1007/978-3-030-50695-7_6]
3. Chauhan AR, Prasad M, Chamariya S, Achrekar S, Mahale SD, Mittal K. Novel FSH receptor mutation in a case of spontaneous ovarian hyperstimulation syndrome with successful pregnancy outcome. J Hum Reprod Sci. 2015;8(4):230-3. [DOI:10.4103/0974-1208.170410] [PMID] [PMCID]
4. Hoeger KM, Dokras A, Piltonen T. Update on PCOS: consequences, challenges, and guiding treatment. J Clin Endocrinol Metab. 2021;106(3):e1071-e1083. [DOI:10.1210/clinem/dgaa839] [PMID]
5. Nagori C. Ovulation Induction in PCOS. In: Handbook of Infertility & Ultrasound for Practicing Gynecologists. Jaypee Brothers Medical Publishers Ltd. 2021:106-119.
6. Smith V, Osianlis T, Vollenhoven B. Prevention of ovarian hyperstimulation syndrome: a review. Obstet Gynecol Int. 2015;2015:514159. [DOI:10.1155/2015/514159] [PMID] [PMCID]
7. Liu F, Jiang Q, Sun X, Huang Y, Zhang Z, Han T, et al. Lipid metabolic disorders and ovarian hyperstimulation syndrome: a retrospective analysis. Front physiol. 2020:11:491892. [DOI:10.3389/fphys.2020.491892] [PMID] [PMCID]
8. Orvieto R, Vanni VS. Ovarian hyperstimulation syndrome following GnRH agonist trigger-think ectopic. J Assist Reprod Genet. 2017;34(9):1161-1165. [DOI:10.1007/s10815-017-0960-0] [PMID] [PMCID]
9. Chen Y, Yang T, Hao C, Zhao J. A retrospective study of letrozole treatment prior to human chorionic gonadotropin in women with polycystic ovary syndrome undergoing in vitro fertilization at risk of ovarian hyperstimulation syndrome. Med Sci Monit. 2018;24:4248-4253. [DOI:10.12659/MSM.910743] [PMID] [PMCID]
10. Tshzmachyan R, Hambartsoumian E. The role of Letrozole (LE) in controlled ovarian stimulation (COS) in patients at high risk to develop ovarian hyper stimulation syndrome (OHSS). A prospective randomized controlled pilot study. J Gynecol Obstet Hum Reprod. 2020;49(2):101643. [DOI:10.1016/j.jogoh.2019.101643] [PMID]
11. He Q, Liang L, Zhang C, Li H, Ge Z, Wang L, et al. Effects of different doses of letrozole on the incidence of early-onset ovarian hyperstimulation syndrome after oocyte retrieval. Syst Biol Reprod Med. 2014;60(6):355-60. [DOI:10.3109/19396368.2014.957879] [PMID]
12. Jellad S, Hassine AH, Basly M, Mrabet A, Chibani M, Rachdi R. Vascular endothelial growth factor antagonist reduces the early onset and the severity of ovarian hyperstimulation syndrome. J Gynecol Obstet Hum Reprod. 2017;46(1):87-91. [DOI:10.1016/j.jgyn.2016.04.002] [PMID]
13. Choudhary RA, Vora PH, Darade KK, Pandey S, Ganla KN. A prospective randomised comparative clinical trial study of luteal phase letrozole versus ganirelix acetate administration to prevent severity of early onset OHSS in ARTs. Int J Fertil Steril. 2021;15(4):263-268.
14. Lamb HM, Adkins JC. Letrozole. Drugs. 1998;56(6):1125-40. [DOI:10.2165/00003495-199856060-00020] [PMID]
15. Marguerie M, Bedaiwy M. Letrozole in fertility therapy. In: Allahbadia GN , Ata B , Lindheim SR , Woodward BJ , Bhagavath B (eds). Textbook of Assisted Reproduction. Singapore: Springer Nature. 2020:53-68. [DOI:10.1007/978-981-15-2377-9_7]
16. EsHRE R. ASRM-Sponsored PCOS Consensus Workshop Group Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil steril. 2004;81(1):19-25. [DOI:10.1016/j.fertnstert.2003.10.004] [PMID]
17. Golan A, Ron-El R, HERMAN A, Soffer Y. Ovarian hyperstimulation syndrome: an update review. Obstet Gynecol Surv. 1989;44(6):430-40. [DOI:10.1097/00006254-198906000-00004] [PMID]
18. Moher D, Hopewell S, Schulz KF, Montori V, Gøtzsche PC, Devereaux P, et al. CONSORT 2010 explanation and elaboration: updated guidelines for reporting parallel group randomised trials. International Journal of Surgery. 2012;10(1):28-55. [DOI:10.1016/j.ijsu.2011.10.001] [PMID]
19. Dumesic DA, Oberfield SE, Stener-Victorin E, Marshall JC, Laven JS, Legro RS. Scientific statement on the diagnostic criteria, epidemiology, pathophysiology, and molecular genetics of polycystic ovary syndrome. Endocr Rev. 2015;36(5):487-525. [DOI:10.1210/er.2015-1018] [PMID] [PMCID]
20. Nagini S. Breast cancer: current molecular therapeutic targets and new players. Anticancer Agents Med Chem. 2017;17(2):152-163. [DOI:10.2174/1871520616666160502122724] [PMID]
21. Bülow NS, Skouby SO, Warzecha AK, Udengaard H, Andersen CY, Holt MD, et al. Impact of letrozole co-treatment during ovarian stimulation with gonadotrophins for IVF: a multicentre, randomized, double-blinded placebo-controlled trial. Hum Reprod. 2022;37(2):309-321. [DOI:10.1093/humrep/deab249] [PMID]
22. Sopa N, Larsen EC, Nyboe Andersen A. Low dose HP-hMG in an antagonist protocol for IVF in ovulatory and anovulatory patients with high AMH. Gynecol Endocrinol. 2018;34(7):623-626. [DOI:10.1080/09513590.2018.1428302] [PMID]
23. Fatemi H, Kyrou D, Papanikolaou E, Al Buarki H, Garcia Velasco J. Letrozole and cabergoline co-administration in the early luteal phase for prevention of OHSS in a high risk patient undergoing ovarian stimulation for IVF. J Fert In Vitro. 2012;2(4).
24. Khadem Ghaebi N, Amirian M, Zarmehri B, Zabihi H. Comparison of the effect of letrozole versus cabergoline for prevention of ovarian hyperstimulation syndrome (OHSS) in patients under ovulation induction treatments and IVF cycles. Iran J Obstet Gynecol Infertil. 2016;18(184):1-8.
25. Mai Q, Hu X, Yang G, Luo Y, Huang K, Yuan Y, et al. Effect of letrozole on moderate and severe early-onset ovarian hyperstimulation syndrome in high-risk women: a prospective randomized trial. Am J Obstet Gynecol. 2017;216(1):42. e1-. e10. [DOI:10.1016/j.ajog.2016.08.018] [PMID]
26. Franik S, Kremer JA, Nelen WL, Farquhar C. Aromatase inhibitors for subfertile women with polycystic ovary syndrome. Cochrane Database Syst Rev. 2014(2):CD010287. [DOI:10.1002/14651858.CD010287.pub2]
27. Hu S, Yu Q, Wang Y, Wang M, Xia W, Zhu C. Letrozole versus clomiphene citrate in polycystic ovary syndrome: a meta-analysis of randomized controlled trials. Arch Obstet Gynaecol. 2018;297(5):1081-1088. [DOI:10.1007/s00404-018-4688-6] [PMID]
28. Legro RS. Ovulation induction in polycystic ovary syndrome: current options. Best Pract Res Clin Obstet Gynaecol. 2016;37:152-159. [DOI:10.1016/j.bpobgyn.2016.08.001] [PMID]

Add your comments about this article : Your username or Email:
CAPTCHA

Send email to the article author


Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

© 2015 All Rights Reserved | Reports of Biochemistry and Molecular Biology

Designed & Developed by : Yektaweb