Effect of GnRH antagonist combined with letrozole regimen on endocrine and pregnancy outcomes of infertile patients with normal ovarian reserve function
Objective:To explore the effect of GnRH antagonist combined with letrozole(LE)regimen for controlled ovarian stimulation(COS)in IVF-ET on endocrine,follicular development and pregnancy outcomes in the infertile patients with normal ovarian reserve function.Methods:A total of 163 patients with normal ovarian reserve function who underwent IVF-ET in the Reproductive Medicine Center of Shijiazhuang fourth Hospital from September 2021 to October 2023 were recruited.The patients were divided into two groups according to whether LE was added to the antagonist regimen for ovulation stimulation.A daily dose of 1.25 mg of LE was added and continuously used until the maximum follicle diameter reached 14 mm In the LE group(n=81),and it was no use in the non-LE group(n=82).The serum levels of estradiol(E2),progesterone,FSH,LH,17-hydroxyprogesterone(17-OH-P),inhibin B(Inh B)and dehydroepiandrosterone(DHEA)were compared between the two groups at different time points during COS regarding stimulation day 1,stimulation day 4,stimulation day 6,3 days before trigger day,1 day before trigger day and the trigger day).The levels of follicular fluid 17-OH-P,Inh B and DHEA on the day of oocyte retrieval,ovulation promotion and clinical pregnancy rate were compared between the two groups.Results:The serum level of E2 in the LE group was significantly lower(P＜0.05)and the serum level of LH was significantly higher(P＜0.05)at other time points except on stimulation day 1 when comparing with the non-LE group during COS period.The serum levels of LH in the LE group were significantly higher than those in the non-LE group on stimulation day 4,or 1 day before trigger day and the trigger day(P＜0.05).The serum level of FSH in LE group was significantly higher than that in non-LE group only on stimulation day 4(P＜0.05).The serum levels of progesterone in the LE group were significantly higher than those in the non-LE group on 1 day before trigger and trigger day(P＜0.05).The serum level of 17-OH-P in the LE group was significantly higher than that of the non-LE group only on the day before trigger(P＜0.05).The serum levels of Inh B in the LE group were significantly higher than those of the non-LE group at other time points except on stimulation day 1(P＜0.05).There were no significant differences in the serum levels of DHEA between the two groups at all time points(P＞0.05).On the day of oocyte retrieval,the levels of 17-OH-P,Inh B and DHEA in follicular fluid in the LE group were significantly higher than those in the non-LE group(P＜0.001).In the LE group,shorter duration of gonadotropin(Gn)use,less total dose of Gn and lower incidence of moderate and severe OHSS as well as less oocyte in M Ⅱ and lower rate of high-quality embryos were found(P＜0.05).There were no significant differences in total number of oocyte retrieval,the fertilization rate,2PN fertilization rate,blastocyst formation rate and clinical pregnancy rate between the two groups(P＞0.05).Conclusions:The addition of modified low-dose of LE(1.25 mg/d)and shortening the duration of administration to the antagonist regimen can obtain a higher number of MⅡ oocytes and high-quality embryos than the antagonist regimen,and significantly shorten the duration of Gn application,the total dose of Gn,and the incidence of moderate and severe OHSS for infertile patients with normal ovarian reserve function.
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