曲唑联合地塞米松，可增加来曲唑抵抗PCOS 患者排卵率？

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BACKGROUND

背景

A common cause of infertility is polycystic ovarian syndrome (PCOS). Guidelines suggest Letrozole should be considered the firstline ovulation induction therapy to improve fertility outcomes. However, approximately 15% of patients may fail to ovulate after receiving letrozole and are considered resistant. Previous studies have evaluated the efficacy of adjuvant dexamethasone in clomiphene-resistant women and have found the combination can successfully induce ovulation in many who fail to respond to clomiphene alone.

多囊卵巢综合征（PCOS）是不孕的常见原因之一。来曲唑为诱导排卵的一线治疗药物。然而约15%的患者在使用来曲唑后仍可能无法排卵，这部分患者被认为是来曲唑抵抗。既往研究已评估了地塞米松辅助治疗在克罗米芬抵抗患者中的疗效，发现该组合可以在许多单独使用克罗米芬无效的女性中成功诱导排卵。

OBJECTIVE

目的

To assess the efficacy of adding dexamethasone to letrozole for ovulation induction in women with letrozole-resistant PCOS. 

评估地塞米松联合来曲唑在来曲唑抵抗的PCOS中诱导排卵的疗效。

MATERIALS AND METHODS

材料和方法

This was a cross-pal study of 23 infertile women with letrozole-resistant PCOS who underwent 36 total cycles of ovulation induction between September 2019 and August 2021. Patients were diagnosed with PCOS according to Rotterdam criteria. Letrozole was initiated on cycle day 3 for 5 days and increased via a stair-step approach to a maximum dose of 7.5mg if there was no ovarian follicular response on transvaginal ultrasound. Patients were deemed letrozole-resistant if no dominant follicle was identified on ultrasound following maximum dose of letrozole. These patients subsequently received 5 additional days of Letrozole 7.5mg with dexamethasone 0.5mg for 7 days and a repeat ultrasound. The primary outcome was ovulation rate (determined by the presence of a dominant follicle on ultrasound).Secondary outcomes included endometrial thickness, number of follicles (>10mm), and live birth rate. Outcomes were analyzed by t-test or Wilcoxon’s rank sum for continuous variables, and Chi-square or Fisher’s exact test for categorical variables. A P-value of <0.05 was considered significant. 

这是一项横断面研究，研究对象为23名对来曲唑抵抗的 PCOS 不孕女性，她们在 2019 年 9 月至 2021 年 8 月期间共经历了 36 个周期的诱导排卵。PCOS根据鹿特丹标准。在周期第3天开始连续使用来曲唑5天，如果经阴道超声检查未发现卵泡反应，则通过阶梯递增法增加至最大剂量 7.5mg/日。如果使用最大剂量的来曲唑后超声检查仍未发现优势卵泡，则认为患者对来曲唑抵抗。这些患者随后再连用 5天来曲唑7.5mg/日和连续7天地塞米松 0.5mg/日，并重复超声检查。主要结局是排卵率（通过超声检查是否存在优势卵泡来确定）。次要结局包括子宫内膜厚度、>10mm卵泡数和活产率。连续变量通过 t 检验或 Wilcoxon 秩和分析结果，分类变量通过卡方检验或 Fisher 精确检验分析结果。P 值 <0.05 被认为是显著的。

RESULT(S)

结果

The ovulation rate for letrozole-resistant PCOS patients who received letrozole and dexamethasone was 30 out of 36 (83%) cycles. Live birth rate for each cycle was 17% with a cumulative patient live birth rate of 29%. Among patients who had a live birth, there was no difference in patient demographics, serum androgens, endometrial thickness, or number of measurable follicles.

接受来曲唑和地塞米松联合治疗的来曲唑抵抗型PCOS 患者的排卵率为 83%（36 个周期中 30 个排卵)。平均每周期活产率为 17%，患者累计活产率为 29%。在活产的患者中，患者人口统计学、血清雄激素、子宫内膜厚度或可测量卵泡数没有差异。

CONCLUSION(S)

结论

The addition of dexamethasone to letrozole increases ovulation rates in letrozole-resistant PCOS patients undergoing ovulation induction. These patients have similar live birth rates to those previously reported for PCOS patients undergoing ovulation induction with letrozole. The addition of dexamethasone can be considered for PCOS patients undergoing ovulation induction with letrozole who are otherwise at risk for cycle cancellation.

在来曲唑联合地塞米松诱导排卵可增加来曲唑抵抗的PCOS 患者的排卵率。这些患者的活产率与之前报道的接受来曲唑诱导排卵的 PCOS 患者的活产率相似。对于接受来曲唑诱导排卵的 PCOS 患者，可以考虑加用地塞米松减少周期取消的风险。

文章来源：

Title: OVULATION INDUCTION WITH LETROZOLE AND DEXAMETHASONE IN INFERTILE PATIENTS WITH LETROZOLE-RESISTANT POLYCYSTIC OVARIAN SYNDROME Neblett, Michael F. et al.Fertility and Sterility, Volume 118, Issue 5, e44 - e46