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Reproductive Biology and Endocrinology
Published in: Reproductive Biology and Endocrinology 1/2020

Open Access 01-12-2020 | Polycystic Ovary Syndrome | Research

The effect of letrozole versus artificial hormonal endometrial preparation on pregnancy outcome after frozen-thawed embryos transfer cycles: a randomized clinical trial

Authors: Azadeh Hosseini-Najarkolaei, Ashraf Moini, Ladan Kashani, Maryam Farid Mojtahedi, Elnaz Hosseini-Najarkolaee, Ensieh Salehi

Published in: Reproductive Biology and Endocrinology | Issue 1/2020

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Abstract

Background

Considering that clinical trial studies are limited in polycystic ovary syndrome (PCOS) patients, and there is no consensus on an optimum endometrial preparation protocol for frozen embryo transfer (FET), the present study was designed as a randomized clinical trial to compare the reproductive outcomes following stimulated cycles with letrozole plus human menopausal gonadotropin (HMG) for endometrial preparation compared with routine AC-FET.

Methods

This randomized controlled trial was carried out on infertile PCOS patients who underwent IVF/ICSI and FET cycles in Arash Women’s Hospital affiliated to Tehran University of Medical Sciences between September 2018 and January 2020. PCOS diagnosis was based on the Rotterdam criteria. Eligible patients were randomly allocated into two groups: stimulated cycle with letrozole plus (HMG) (intervention group) and routine artificial hormonal endometrial preparation (control group).

Results

One hundred seventy-seven infertile patients were recruited for participation in the study. Of these, 57 women were excluded due to non-eligibility for entering the study, and a total of 120 patients were randomly assigned to two study groups. After follow up, the cycle outcomes of 57 patients in the intervention group and 59 patients in the control group were compared. The data analysis showed that the two groups did not have significant differences in fundamental and demographic characteristics. After the intervention, there were no significant differences in implantation rate, chemical, ectopic, and clinical pregnancy rates between groups. Moreover, the rates of miscarriage and ongoing pregnancy were similar between groups (P > 0.05).

Conclusions

We found similar pregnancy outcomes with two endometrial preparation methods. Noting that each treatment centre should select the most beneficial and cost-effective method with the least adverse effects for patients, letrozole preparations for FET could be incorporated into possible options; however, establishing this approach as first-line treatment is premature in light of current evidence, and future randomized clinical trials with larger sample sizes are required for widespread application.

Trial registration

The study was also registered in the Iranian Registry of Clinical Trials on March 20th, 2020. (IRCT200905260019​52N12 at www.​irct.​ir, registered retrospectively).
Literature
1.
Melo AS, Ferriani RA, Navarro PA. Treatment of infertility in women with polycystic ovary syndrome: approach to clinical practice. Clinics. 2015;70(11):765–9.PubMedPubMedCentralCrossRef
2.
Zhang J, Liu H, Wang Y, Mao X, Chen Q, Fan Y, et al. Letrozole use during frozen embryo transfer cycles in women with polycystic ovary syndrome. Fertil Steril. 2019.
3.
Roque M, Valle M, Guimarães F, Sampaio M, Geber S. Cost-effectiveness of the freeze-all policy. JBRA assisted reproduction. 2015;19(3):125–30.PubMedCrossRef
4.
Groenewoud E, Cohlen B, Al-Oraiby A, Brinkhuis E, Broekmans F, De Bruin J, et al. A randomized controlled, non-inferiority trial of modified natural versus artificial cycle for cryo-thawed embryo transfer. Hum Reprod. 2016;31(7):1483–92.PubMedPubMedCentralCrossRef
5.
Ghobara T, Gelbaya TA, Ayeleke RO. Cycle regimens for frozen-thawed embryo transfer. Cochrane Database Syst Rev. 2017;7.
6.
Behnam-Rasouli M, Nikravesh MR. The Abortional and the Teratogenical effects of 17-beta estradiol Valerate administration during embryonic development in rats. Iran Biomed J. 1997;1(4):53–7.
7.
Wright KP, Guibert J, Weitzen S, Davy C, Fauque P, Olivennes F. Artificial versus stimulated cycles for endometrial preparation prior to frozen–thawed embryo transfer. Reprod BioMed Online. 2006;13(3):321–5.PubMedCrossRef
8.
Jouan C, Emonard V, Ruggeri P, Debelle L, Hincourt N, Lorquet S, et al. Pregnancy outcome following frozen embryo transfer after artificial cycle or treatment by clomiphene citrate. Gynecol Endocrinol. 2016;32(10):807–10.PubMedCrossRef
9.
Tahoon AS, Abdrabo HA, Mustafa MK. Randomized controlled trial comparing pregnancy outcome using artificial versus letrozole stimulated cycle in cryo preserved embryo transfer. Egypt J Hosp Med. 2018;72(6):4644–9.
10.
Hatoum I, Bellon L, Swierkowski N, Ouazana M, Bouba S, Fathallah K, et al. Disparities in reproductive outcomes according to the endometrial preparation protocol in frozen embryo transfer. J Assist Reprod Genet. 2018;35(3):425–9.PubMedCrossRef
11.
S-j L, Y-j Z, X-s C, M-f N, Y-y Z, J-l C, et al. Letrozole ovulation induction: an effective option in endometrial preparation for frozen–thawed embryo transfer. Arch Gynecol Obstet. 2014;289(3):687–93.CrossRef
12.
Sibai H, El Husseiny A, Elgindy E. Letrozole versus artificial hormonal endometrial preparation for vitrified–warmed embryos transfer cycles. Middle East Fertility Soc J. 2016;21(2):96–100.CrossRef
13.
Yu J, Ma Y, Wu Z, Li Y, Tang L, Li Y, et al. Endometrial preparation protocol of the frozen-thawed embryo transfer in patients with polycystic ovary syndrome. Arch Gynecol Obstet. 2015;291(1):201–11.PubMedCrossRef
14.
Aleyasin A, Aghahosseini M, Safdarian L, Noorzadeh M, Fallahi P, Rezaeian Z, et al. Can letrozole plus HMG protocol improve pregnancy outcomes in frozen-thawed embryo transfer? An RCT. Int J Reprod BioMed. 2017;15(2):83.PubMedPubMedCentralCrossRef
15.
Garcia-Velasco JA. The use of aromatase inhibitors in in vitro fertilization. Fertil Steril. 2012;98(6):1356–8.PubMedCrossRef
16.
Wallace KL, Johnson V, Sopelak V, Hines R. Clomiphene citrate versus letrozole: molecular analysis of the endometrium in women with polycystic ovary syndrome. Fertil Steril. 2011;96(4):1051–6.PubMedCrossRef
17.
Cummins J, Breen T, Harrison K, Shaw J, Wilson L, Hennessey J. A formula for scoring human embryo growth rates in in vitro fertilization: its value in predicting pregnancy and in comparison with visual estimates of embryo quality. J In Vitro Fertil Embryo Transfer. 1986;3(5):284–95.CrossRef
18.
Singh B, Reschke L, Segars J, Baker VL. Frozen-thawed embryo transfer: the potential importance of the corpus luteum in preventing obstetrical complications. Fertil Steril. 2020;113(2):252–7.PubMedPubMedCentralCrossRef
19.
Hu YJ, Chen YZ, Zhu YM, Huang HF. Letrozole stimulation in endometrial preparation for cryopreserved–thawed embryo transfer in women with polycystic ovarian syndrome: a pilot study. Clin Endocrinol. 2014;80(2):283–9.CrossRef
20.
Tatsumi T, Jwa S, Kuwahara A, Irahara M, Kubota T, Saito H. Pregnancy and neonatal outcomes following letrozole use in frozen-thawed single embryo transfer cycles. Hum Reprod. 2017;32(6):1244–8.PubMedCrossRef
21.
Peigné M, Devouche E, Ferraretto X, Gricourt S, Luton D, Patrat C, et al. Higher live birth rate with stimulated rather than artificial cycle for frozen-thawed embryo transfer. Eur J Obstet Gynecol Reprod Biol. 2019;243:144–9.PubMedCrossRef
22.
Miller PB, Parnell BA, Bushnell G, Tallman N, Forstein DA, Higdon HL III, et al. Endometrial receptivity defects during IVF cycles with and without letrozole. Hum Reprod. 2012;27(3):881–8.PubMedPubMedCentralCrossRef
23.
Ganesh A, Chauhan N, Das S, Chakravarty B, Chaudhury K. Endometrial receptivity markers in infertile women stimulated with letrozole compared with clomiphene citrate and natural cycles. Syst Biol Reprod Med. 2014;60(2):105–11.PubMedCrossRef
24.
Tatsumi T, Jwa S, Kuwahara A, Irahara M, Kubota T, Saito H. No increased risk of major congenital anomalies or adverse pregnancy or neonatal outcomes following letrozole use in assisted reproductive technology. Hum Reprod. 2017;32(1):125–32.PubMed
Metadata
Title
The effect of letrozole versus artificial hormonal endometrial preparation on pregnancy outcome after frozen-thawed embryos transfer cycles: a randomized clinical trial
Authors
Azadeh Hosseini-Najarkolaei
Ashraf Moini
Ladan Kashani
Maryam Farid Mojtahedi
Elnaz Hosseini-Najarkolaee
Ensieh Salehi
Publication date
01-12-2020
Publisher
BioMed Central
Published in
Reproductive Biology and Endocrinology / Issue 1/2020
Electronic ISSN: 1477-7827
DOI
https://doi.org/10.1186/s12958-020-00675-z

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