Abstract:Background: Progestin is an alternative to gonadotropin-releasing hormone (GnRH) analogues in the follicular phase to suppress the premature luteinizing hormone (LH) surge in women with polycystic ovary syndrome (PCOS). However, progestin-primed ovarian stimulation (PPOS) is always accompanied by increased pituitary suppression and gonadotropin consumption. Previous studies suggested that letrozole appeared to have the potential to reduce the total gonadotropin dose required for ovarian stimulation. A retrospe… Show more
“…The results suggested that the clinical pregnancy of patients with the Le PPOS protocol was significantly higher than with the traditional PPOS protocol. Those results are supported by a previous study that showed higher implantation rates with Le PPOS compared with PPOS in patients with PCOS 20 . This study is unique in that the PSM method was used; the advantages of Le PPOS can be better reflected when the characteristics of the two groups are similar.…”
Section: Discussionsupporting
confidence: 83%
“…MPA cotreatment starting on MC3 can block the premature LH surge, but this strategy will fail if MPA is started during the mid‐follicular phase, at least in women with multiple follicles and high E2 levels 6 . In the present study, MPA was used from MC6 in the Le PPOS group, and there were no premature LH surges, as previously observed in women with polycystic ovary syndrome (PCOS) 20 . The results suggest that letrozole might create an environment with low estrogen levels and allow a reduced time and dose of MPA.…”
Section: Discussionmentioning
confidence: 64%
“…6 In the present study, MPA was used from MC6 in the Le PPOS group, and there were no premature LH surges, as previously observed in women with polycystic ovary syndrome (PCOS). 20 The results suggest that letrozole might create an environment with low estrogen levels and allow a reduced time and dose of MPA. Therefore, pituitary inhibition largely caused by MPA accumulation was avoided.…”
Section: Characteristicsmentioning
confidence: 93%
“…Those results are supported by a previous study that showed higher implantation rates with Le PPOS compared with PPOS in patients with PCOS. 20 This study is unique in that the PSM method was used; the advantages of Le PPOS can be better reflected when the characteristics of the two groups are similar. In addition, the number of oocytes obtained, the number of fertilized oocytes, and the number of available embryos in the Le PPOS group were superior to the traditional PPOS.…”
AimTo investigate the impact of letrozole cotreatment progestin‐primed ovarian stimulation (PPOS) (Le PPOS) in controlled ovarian stimulation (COS) and the pregnancy outcomes in frozen–thawed embryo transfer cycles.MethodsThis retrospective cohort study included women who underwent in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI). A total of 2575 cycles were included (1675 in the Le PPOS group and 900 in the PPOS group). The primary outcome was the clinical pregnancy rates. The secondary outcome was the live birth rates.ResultsIn this study, propensity score matching (PSM) was performed to create a perfect match of 379 patients in each group. After matching, the numbers of oocytes retrieved, mature oocytes, fertilization, and clinical pregnancy rates were more favorable in the Le PPOS group than in the PPOS group (all p < 0.05). The multivariable analysis showed that the clinical pregnancy rate was higher in the Le PPOS than in the PPOS group (odds ratio = 1.46, 95% confidence interval: 1.05–2.04, p = 0.024) after adjusting for potentially confounding factors (age, anti‐Müllerian hormone levels, antral follicular count, the type of embryo transferred, number of transferred embryos, body mass index, and follicular stimulating hormone and estradiol levels on starting day).ConclusionsThis retrospective study with a limited sample size suggests that the Le PPOS protocol might be an alternative to the PPOS protocol in women undergoing COS and could lead to better pregnancy outcomes. The results should be confirmed using a formal randomized controlled trial.
“…The results suggested that the clinical pregnancy of patients with the Le PPOS protocol was significantly higher than with the traditional PPOS protocol. Those results are supported by a previous study that showed higher implantation rates with Le PPOS compared with PPOS in patients with PCOS 20 . This study is unique in that the PSM method was used; the advantages of Le PPOS can be better reflected when the characteristics of the two groups are similar.…”
Section: Discussionsupporting
confidence: 83%
“…MPA cotreatment starting on MC3 can block the premature LH surge, but this strategy will fail if MPA is started during the mid‐follicular phase, at least in women with multiple follicles and high E2 levels 6 . In the present study, MPA was used from MC6 in the Le PPOS group, and there were no premature LH surges, as previously observed in women with polycystic ovary syndrome (PCOS) 20 . The results suggest that letrozole might create an environment with low estrogen levels and allow a reduced time and dose of MPA.…”
Section: Discussionmentioning
confidence: 64%
“…6 In the present study, MPA was used from MC6 in the Le PPOS group, and there were no premature LH surges, as previously observed in women with polycystic ovary syndrome (PCOS). 20 The results suggest that letrozole might create an environment with low estrogen levels and allow a reduced time and dose of MPA. Therefore, pituitary inhibition largely caused by MPA accumulation was avoided.…”
Section: Characteristicsmentioning
confidence: 93%
“…Those results are supported by a previous study that showed higher implantation rates with Le PPOS compared with PPOS in patients with PCOS. 20 This study is unique in that the PSM method was used; the advantages of Le PPOS can be better reflected when the characteristics of the two groups are similar. In addition, the number of oocytes obtained, the number of fertilized oocytes, and the number of available embryos in the Le PPOS group were superior to the traditional PPOS.…”
AimTo investigate the impact of letrozole cotreatment progestin‐primed ovarian stimulation (PPOS) (Le PPOS) in controlled ovarian stimulation (COS) and the pregnancy outcomes in frozen–thawed embryo transfer cycles.MethodsThis retrospective cohort study included women who underwent in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI). A total of 2575 cycles were included (1675 in the Le PPOS group and 900 in the PPOS group). The primary outcome was the clinical pregnancy rates. The secondary outcome was the live birth rates.ResultsIn this study, propensity score matching (PSM) was performed to create a perfect match of 379 patients in each group. After matching, the numbers of oocytes retrieved, mature oocytes, fertilization, and clinical pregnancy rates were more favorable in the Le PPOS group than in the PPOS group (all p < 0.05). The multivariable analysis showed that the clinical pregnancy rate was higher in the Le PPOS than in the PPOS group (odds ratio = 1.46, 95% confidence interval: 1.05–2.04, p = 0.024) after adjusting for potentially confounding factors (age, anti‐Müllerian hormone levels, antral follicular count, the type of embryo transferred, number of transferred embryos, body mass index, and follicular stimulating hormone and estradiol levels on starting day).ConclusionsThis retrospective study with a limited sample size suggests that the Le PPOS protocol might be an alternative to the PPOS protocol in women undergoing COS and could lead to better pregnancy outcomes. The results should be confirmed using a formal randomized controlled trial.
“…Previous research has shown that 10 mg of MPA effectively inhibits spontaneous ovulation, whereas 5 mg does not yield the same results ( 11 ). However, conflicting findings have been reported regarding the appropriate MPA dosage for preventing untimely LH surges, with some studies suggesting that daily doses of 4 mg ( 12 , 13 ) or 6 mg ( 3 , 6 ) are sufficient. In our previous study, we demonstrated that coadministration of letrozole (LE) with MPA during ovarian stimulation for IVF achieved comparable embryo and pregnancy outcomes while reducing the required MPA dosage ( 14 ).…”
ObjectiveTo explore the cycle characteristics and pregnancy outcomes of progestin-primed ovarian stimulation (PPOS) using fixed versus degressive doses of medroxyprogesterone acetate (MPA) in conjunction with letrozole (LE) in infertile women by propensity score matching (PSM) analysis.DesignA retrospective cohort study.SettingTertiary-care academic medical center.PopulationA total of 3173 infertile women undergoing their first in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) treatment within the period from January 2017 to December 2020.MethodsA total of 1068 and 783 patients who underwent a fixed dose of MPA combined with LE and a degressive dose of MPA combined with LE protocols, respectively, were enrolled in this study. The freeze-all approach and later frozen-thawed embryo transfer (FET) were performed in both groups. Propensity score matching (1:1) was performed.Main outcome measuresThe primary outcomes were the dosage of MPA and the incidence of premature luteinizing hormone (LH) surges. The secondary outcomes were the number of oocytes retrieved, the cumulative live birth rate (CLBR) and the fetal malformation rate.ResultsWe created a perfect match of 478 patients in each group. The dosage of MPA, the LH serum level on the eighth day of stimulation, progesterone (P) level and LH level on the hCG trigger day were significantly higher in the LE + fixed MPA group than in the LE + degressive MPA group (52.1 ± 13.1 mg vs. 44.9 ± 12.5 mg; 5.0 ± 2.7 IU/L vs. 3.7 ± 1.7 IU/L; 0.9 ± 0.5 ng/ml vs. 0.8 ± 0.5 ng/ml; 3.3 ± 2.4 IU/L vs. 2.8 ± 1.9 IU/L; P < 0.01). The duration of Gn, the number of follicles with diameter more than 16 mm on trigger day, the estradiol (E2) level on the hCG trigger day were lower in the LE + fixed MPA group than in the LE + degressive MPA group (9.7 ± 1.7 days vs. 10.3 ± 1.5 days; 5.6 ± 3.0 vs. 6.3 ± 3.0; 1752.5 ± 1120.8 pg/ml vs. 1997.2 ± 1108.5 pg/ml; P < 0.001). No significant difference was found in the incidence of premature LH surge, the number of oocytes retrieved, the number of top-quality embryos, clinical pregnancy rate (CPR), CLBR or fetal malformation rate between the two groups.ConclusionThe combination of a degressive MPA dose with LE proved effective in reducing the total MPA dosage with comparable premature LH surge and pregnancy outcomes in women undergoing the PPOS protocol.
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