PREGNANCY RATE FOLLOWING LUTEAL PHASE SUPPORT IN POLYCYSTIC OVARY WOMEN USING LETROZOLE WITH OR WITHOUT GONADOTROPIN AS OVULATION INDUCTION
Objective: The objective of the study was to evaluate the effect of luteal phase progesterone supplementation on pregnancy rates in anovulatory infertile polycystic ovary women using letrozole with or without gonadotropin as ovulation induction (OI).
Method: A prospective randomized clinical study conducted in the infertility clinic - Al-Yarmouk Teaching Hospital, Baghdad/Iraq from June 2016 to January 2018. A total of 149 infertile polycystic ovary women who achieved ovulation using letrozole alone or with gonadotropin as OI protocol enrolled. Accordingly, the study group divided into two: Group A (letrozole group, no=99) and Group B (letrozole gonadotropin group, no=50). After triggering with human Chorionic Gonadotropin, the women in each group were randomly divided into two subgroup women with luteal phase support (LPS) and women without. The primary outcome measure was pregnancy rate.
Results: The study shows that pregnancy rate was higher with letrozole group using LPS although the difference did not reach statistical significant (p=0.08). After adjustment of possible confounders; patients receiving letrozole with gonadotropin with LPS had significantly higher successful pregnancy rate.
Conclusion: Administration of LPS after OI in infertile polycystic ovarian syndrome women may improve pregnancy rate.
2. Qureshi SS, Gupta JK, Shah K, Upmanyu N. Prevalence and risk factor of polycystic ovarian syndrome. Asian J Pharm Clin Res 2016;9:23-5.
3. Teede H, Deeks A, Moran L. Polycystic ovary syndrome: A complex conditions with psychological, reproductive and metabolic manifestations that impact on health across the lifespan. BMC Med 2010;8:41.
4. Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril 2004;81:19-25.
5. Haqnawaz F, Virk S, Qadir T, Imam S, Rizvi J. Comparison of letrozole and clomiphene citrate efficacy alongwith gonadotrophins in controlled ovarian hyperstimulation for intrauterine insemination cycles. J Reprod Infertil 2013;14:138-42.
6. Franik S, Kremer JA, Nelen WL, Farquhar C. Aromatase inhibitors for subfertile women with polycystic ovary syndrome. Cochrane Database Syst Rev 2014;2:CD010287.
7. Legro RS, Kunselman AR, Brzyski RG, Casson PR, Diamond MP, Schlaff WD, et al. The pregnancy in polycystic ovary syndrome II (PPCOS II) trial: Rationale and design of a double-blind randomized trial of clomiphene citrate and letrozole for the treatment of infertility in women with polycystic ovary syndrome. Contemp Clin Trials 2012;33:470-81.
8. Teede HJ, Misso ML, Deeks AA, Moran LJ, Stuckey BG, Wong JL, et al. Assessment and management of polycystic ovary syndrome: Summary of an evidence-based guideline. Med J Aust 2011;195:S65-112.
9. Lo Monte G, Piva I, Bazzan E, Marci R, OgrinC. Luteal phase support for assisted reproductive technologies: Between past, present and future. Minerva Endocrinol 2013;38:401-14.
10. Miller P, Soules M. Luteal phase deficiency: Pathophysiology, diagnosis and treatment. In: Gynecology and obstetrics. London: Global Library Womenâ€™s Med; 2009.
11. Boutzios G, Karalaki M, Zapanti E. Common pathophysiological mechanisms involved in luteal phase deficiency and polycystic ovary syndrome. Impact on fertility. Endocrine 2013;43:314-7.
12. Yazici G, Savas A, Tasdelen B, Dilek S. Role of luteal phase support gonadotropin ovulation induction cycles in patients with polycystic ovary syndrome. J Reprod Med 2014;59:25-30.
13. Baby A, Varghese AA, Jose C, Kandasamy K, Rajagopal SS. A prospective evaluation of causes and treatment of infertility in a tertiary care hospital, Erode. Asian J Pharm Clin Res 2018;11:149-53.
14. Hubayter ZR, Muasher SJ. Luteal supplementation in vitro fertilization: More questions than answers. Fertil Steril 2008;89:749-58.
15. Blank SK, McCartney CR, Marshall JC. The origins and sequelae of abnormal neuroendocrine function in polycystic ovary syndrome. Hum Reprod Update 2006;12:351-61.
16. Montville CP, Khabbaz M, Aubuchon M, Williams DB, Thomas MA. Luteal support with intravaginal progesterone increases clinical pregnancy rates in women with polycystic ovary syndrome using letrozole for ovulation induction. Fertil Steril 2010;94:678-83.
17. Foroozanfard F, Saberi H, Moraveji SA, Bazarganipour F. Pregnancy rate following luteal phase support in Iranian women with polycystic ovarian syndrome. Int J Fertil Steril 2014;8:235-42.
18. Yazici G, Savas A, Tasdelen B, Dilek S. Role of luteal phase support on gonadotropin ovulation induction cycles in patients with polycystic ovary syndrome. J Reprod Med 2014;59:25-30.
19. Hill MJ, Whitcomb BW, Lewis TD, Wu M, Terry N, DeCherney AH, et al. Progesterone luteal support after ovulation induction and intrauterine insemination: A systematic review and meta-analysis. Fertil Steril 2013;100:1373-80.
20. Malik S, Verma S, Jain K, Talwar P, Dhorepatiletc B. Good clinical practice recommendations on management of infertility in patients from India with polycystic ovary syndrome. Fertil Sci Res 2015;2:107-32.
21. Barbosa MW, Silva LR, Navarro PA, Ferriani RA, Nastri CO, Martins WP, et al. Dydrogesterone vs progesterone for luteal-phase support: Systematic review and meta-analysis of randomized controlled trials. Ultrasound Obstet Gynecol 2016;48:161-70.
22. Tournaye H, Sukhikh GT, Kahler E, Griesinger G. A phase III randomized controlled trial comparing the efficacy, safety and tolerability of oral dydrogesterone versus micronized vaginal progesterone for luteal support in in vitro fertilization. Hum Reprod 2017;32:1019-27.
23. Salehpour S, Tamimi M, Saharkhiz N. Comparison of oral dydrogesterone with suppository vaginal progesterone for luteal-phase support in in vitro fertilization (IVF): A randomized clinical trial. Iran J Reprod Med 2013;11:913-8.
24. Chakravarty BN, Shirazee HH, Dam P, Goswami SK, Chatterjee R, Ghosh S, et al. Oral dydrogesterone versus intravaginal micronised progesterone as luteal phase support in assisted reproductive technology (ART) cycles: Results of a randomised study. J Steroid Biochem Mol Biol 2005;97:416-20.
The publication is licensed under CC By and is open access. Copyright is with author and allowed to retain publishing rights without restrictions.