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. 2024 Jul 8:18:2823-2835.
doi: 10.2147/DDDT.S458608. eCollection 2024.

The Efficacy of Letrozole Co-Treatment in an Antagonist Protocol for Women with Polycystic Ovary Syndrome Undergoing IVF: A Retrospective Study

Jing Lin  1 , Fenglu Wu  2 , Yanwen Zhu  2 , Qianqian Zhu  2 , Tong Du  2 , Jiaying Lin  2
Affiliations

The Efficacy of Letrozole Co-Treatment in an Antagonist Protocol for Women with Polycystic Ovary Syndrome Undergoing IVF: A Retrospective Study

Jing Lin et al. Drug Des Devel Ther. .

Abstract

Objective: Our objective was to investigate the efficacy of letrozole co-treatment in an antagonist protocol for infertile women with polycystic ovary syndrome (PCOS).

Patients and methods: This retrospective cohort study included infertile women with PCOS undergoing IVF/ICSI with and without letrozole co-treatment in an antagonist protocol from 2007-2021 at Shanghai Ninth People's Hospital (Shanghai, China). A total of 1559 participants were enrolled, with 1227 women in the antagonist group and 332 women in the letrozole co-treatment group. Propensity score-based patient-matching model was conducted to balance covariates between the groups. The primary outcome was the number of retrieved oocytes, with secondary outcomes including endocrine parameters, ovarian stimulation outcomes, pregnancy outcomes, and obstetrical and neonatal complications.

Results: Letrozole co-treatment induced significant changes in hormonal regulation, increased the percentage of large follicles, and resulted in fewer retrieved oocytes (P < 0.05). However, there was no negative impact on the number of usable embryos or good-quality embryos (P > 0.05). The live birth rates following fresh embryo transfer were comparable between the letrozole and control groups (single embryo transfer: 28.9% vs 29.7%, P > 0.05; double embryo transfer: 37.3% vs 45.6%, P > 0.05). Additionally, there were no significant differences between the two groups in the live birth rate per patient after frozen embryo transfer and the cumulative live birth rate (P > 0.05). No significant differences in obstetrical and neonatal complications were observed between the groups (P > 0.05).

Conclusion: The addition of letrozole to the antagonist protocol for women with PCOS undergoing IVF induces a higher percentage of large follicles during oocyte retrieval, while reducing the overall number of retrieved oocytes. Moreover, the use of letrozole demonstrates comparable clinical outcomes following embryo transfers. These findings highlight the potential application of letrozole in an antagonist protocol for women with PCOS.

Keywords: antagonist protocol; follicle; in vitro fertilization; letrozole; polycystic ovary syndrome.

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Conflict of interest statement

The authors declare no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Hormone profiles in women with PCOS undergoing IVF with and without letrozole co-treatment. Hormone levels were measured at the start of ovarian stimulation and on the day of the ovulation trigger. The data are presented using box plots, which visually display the median, interquartile range (representing the middle 50% of the values), and the range (excluding any outliers). Statistical significance is indicated as “***” for P < 0.001.
Figure 2
Figure 2
Follicle recruitment in women with PCOS undergoing IVF with and without letrozole co-treatment. (A) Comparison of the number of follicles. The numbers are depicted using purple bars (GnRH antagonist group) and red bars (letrozole co-treatment group). (B) The percentage of follicles categorized by size. Data are represented by a color gradient from light green to dark green, corresponding to the follicle size (>16mm, 14–16mm, 12–14mm, 10–12mm, and <10mm), respectively.
Figure 3
Figure 3
Embryonic parameters in women with PCOS undergoing IVF with and without letrozole co-treatment. Comparison of the numbers of retrieved, matured and fertilized oocytes, as well as the numbers of cleaved, usable, and good-quality embryos. The numbers are depicted using purple bars (GnRH antagonist group) and red bars (letrozole co-treatment group). Statistical significance is indicated as “***” for P < 0.001.
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Grants and funding

This study was funded by the National Natural Science Foundation of China (Grant Nos. 82271693 and 82201912), and the Shanghai Sailing Program (21YF1423200).

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