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Letrozole use in vitrified single-blastocyst transfer cycles is associated with lower risk of large for gestational age infants in patients with polycystic ovary syndrome

  • Assisted Reproduction Technologies
  • Published:
Journal of Assisted Reproduction and Genetics Aims and scope Submit manuscript

Abstract

Purpose

To evaluate the obstetric and perinatal outcomes of three routine endometrial preparation protocols in women with PCOS who underwent frozen embryo transfer (FET).

Methods

This was a retrospective study in women with PCOS who underwent FET in an academic reproductive medical center. A total of 2710 cycles were enrolled and classified into three groups according to different endometrial preparation protocols; human menopausal gonadotropin (HMG), letrozole + HMG, or hormone replacement therapy (HRT).

Results

The stimulation groups had reduced risks of hypertensive disorders of pregnancy (HDP), large for gestational age (LGA) infants, and cesarean delivery than the HRT group. After adjustment for different confounder combinations in the two models, the frequencies of LGA and HDP in the letrozole + HMG group and the HMG group were still significantly lower than those in the HRT group. The letrozole + HMG group exhibited a reduced risk of LGA than HMG group after adjustment of confounders. A trend toward risk reductions in HDP and LGA was observe in turns of HRT, HMG, and letrozole + HMG groups, and the trends were statistically significant (Ptrend = 0.031 and 0.001).

Conclusion

In patients with PCOS, ovarian stimulation protocols for endometrial preparation are associated with reduced risks of HDP and LGA compared to HRT cycles. The use of letrozole could further reduce risk of LGA compared to HMG only protocol. We propose that ovarian stimulation protocols can be used widely for endometrial preparation in FET cycles in women with PCOS, especially with the use of letrozole.

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Abbreviations

PCOS:

Polycystic ovary syndrome

FET:

Frozen embryo transfer

HMG:

Human menopausal gonadotropin

HRT:

Hormone replacement therapy

HDP:

Hypertensive disorders of pregnancy

LGA:

Large for gestational age

IVF:

In vitro fertilization

ET:

Embryo transfer

OHSS:

Ovarian hyperstimulation syndrome

OS:

Ovarian stimulation

LH:

Luteinizing hormone

GDP:

Gestational diabetes mellitus

SGA:

small for gestational age

PPH:

Postpartum hemorrhage

FSH:

Follicle-stimulating hormone

AFC:

Antral follicle counta

OR:

Adjusted odds ratio

CI:

Confidence interval

CL:

Corpus luteum

cfPWV:

Carotid-femoral pulse wave velocity

cfPWTT:

Carotid-femoral pulse wave transit time

ICSI:

Intracytoplasmic sperm injection

PGT:

Preimplantation genetic testing

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Acknowledgements

The authors thank the medical workers in the research group at the Reproductive Hospital of Shandong University and also thank the information engineer for assembling the data.

Funding

This study was supported by the National Key Research and Development Program of China (2021YFC2700404).

Author information

Authors and Affiliations

  1. Center for Reproductive Medicine, the Second Hospital, Cheeloo College of Medicine, Shandong University, No.247 Beiyandajie Road, Jinan, 250000, Shandong, China

    Yiting Zhang, Xiao Fu, Shuli Gao, Shuzhe Gao, Shanshan Gao, Jinlong Ma & Zi-Jiang Chen

  2. Key laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, 250012, Shandong, China

    Yiting Zhang, Xiao Fu, Shuli Gao, Shuzhe Gao, Shanshan Gao, Jinlong Ma & Zi-Jiang Chen

  3. Shandong Key Laboratory of Reproductive Medicine, Jinan, 250012, Shandong, China

    Yiting Zhang, Xiao Fu, Shuli Gao, Shuzhe Gao, Shanshan Gao, Jinlong Ma & Zi-Jiang Chen

  4. Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, 250012, Shandong, China

    Yiting Zhang, Xiao Fu, Shuli Gao, Shuzhe Gao, Shanshan Gao, Jinlong Ma & Zi-Jiang Chen

  5. Shandong Technology Innovation Center for Reproductive Health, Jinan, 250012, Shandong, China

    Yiting Zhang, Xiao Fu, Shuli Gao, Shuzhe Gao, Shanshan Gao, Jinlong Ma & Zi-Jiang Chen

  6. National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, 250012, Shandong, China

    Yiting Zhang, Xiao Fu, Shuli Gao, Shuzhe Gao, Shanshan Gao, Jinlong Ma & Zi-Jiang Chen

  7. Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics, Shanghai, 200135, China

    Zi-Jiang Chen

  8. Center for Reproductive Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200135, China

    Zi-Jiang Chen

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  1. Yiting Zhang
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  3. Shuli Gao
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Correspondence to Shanshan Gao.

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The ethics committee at the Reproductive Hospital of Shandong University approved the study protocol.

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Zhang, Y., Fu, X., Gao, S. et al. Letrozole use in vitrified single-blastocyst transfer cycles is associated with lower risk of large for gestational age infants in patients with polycystic ovary syndrome. J Assist Reprod Genet 40, 2885–2894 (2023). https://doi.org/10.1007/s10815-023-02956-z

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