Abstract
ObjectiveTo evaluate the clinical effect of mild stimulation with letrozole on pregnancy outcomes in ovulatory women undergoing frozen embryo transfer (FET) compared to natural cycle.DesignRetrospective observational study.SettingTertiary care academic medical center.PopulationA total of 6,874 infertile women with regular menstrual cycles (21-35 days) met the criteria for this study in the period from 2013 to 2020.MethodsAll patients who were prepared for and underwent FET were divided into two groups: a modified natural cycle (NC) group (n=3,958) and a letrozole cycle group (n=2,916).Main Outcome MeasuresThe primary outcome of the study was clinical pregnancy rate. Secondary outcome measures were endometrial thickness, rates of implantation, positive HCG test, live birth, early miscarriage and ectopic pregnancy.ResultsThe clinical pregnancy rate was not statistically different between the modified NC-FET group and the letrozole-FFT group before (crude OR 0.99, 95% CI 0.90-1.09, P=0.902>0.05) and after propensity score matching (PSM) (crude OR 1.01, 95% CI 0.91-1.12, P=0.870>0.05). After multivariable logistic regression analysis, the clinical pregnancy rate remained insignificant before (adjusted OR 1.00, 95% CI 0.91-1.10, P=0.979>0.05) and after matching (adjusted OR 1.00, 95% CI 0.89-1.11, P=0.936>0.05), respectively. Similarly, in the crude and adjusted analysis, the positive HCG test, implantation, live birth and early miscarriage rates were also comparable in the letrozole-FFT group and modified NC-FET group before and after matching. Furthermore, the endometrial thickness of letrozole-FFT group was similar to that of modified NC-FET group with adjusted analysis.ConclusionOur observation suggests that mild stimulation with letrozole could produce similar pregnancy outcomes in ovulatory patients who undergo FET when compared with a natural cycle.
Highlights
Implantation is a critical step of successful in vitro fertilization (IVF) therapy for infertile couples
Our recent observational study revealed that mild stimulation with letrozole for endometrial preparation was associated with a higher live birth rate compared to an hormone replacement therapy (HRT) group in patients with polycystic ovary syndrome (PCOS) undergoing frozen embryo transfer (FET) [12]
Between November 2013 and December 2020, a total of 6,874 women with regular menstruation (21-35 days) who were enrolled in this study were stratified into two cohorts: modified natural cycle FET (NC-FET) and letrozole cycle FET (L-FET)
Summary
Implantation is a critical step of successful in vitro fertilization (IVF) therapy for infertile couples. Letrozole, a third-generation aromatase inhibitor, does not antagonize estrogen receptors and maintains the normal central feedback required to facilitate normal follicular growth, selection of dominant follicles and ovulation without negatively affecting the endometrium [9] It is noticed whether letrozole use could benefit pregnancy outcomes when compared with natural or hormone replacement therapy (HRT) cycles. Mild stimulation with letrozole was demonstrated to be associated with a significantly higher maximal endometrial thickness and higher rates of clinical pregnancy, ongoing pregnancy, and implantation compared to using hormonal manipulation or HMG stimulation in endometrial preparation for FET in polycystic ovary syndrome (PCOS) patients [11]. Our recent observational study revealed that mild stimulation with letrozole for endometrial preparation was associated with a higher live birth rate compared to an HRT group in patients with PCOS undergoing FET [12].
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