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已发表论文
一种用于多囊卵巢综合征且来曲唑耐药女性诱导排卵的新型来曲唑阶梯式疗程方案
Authors Zhu X, Lang J, Zhi Y, Wang Q, Fu Y
Received 2 May 2025
Accepted for publication 15 August 2025
Published 29 September 2025 Volume 2025:19 Pages 8793—8803
DOI https://doi.org/10.2147/DDDT.S538102
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Dr Leonidas Panos
Xiuxian Zhu,1– 3,* Jingwen Lang,1,2,* Yunqing Zhi,1,2 Qiaoling Wang,1,2 Yonglun Fu1– 3
1Department of Assisted Reproductive Medicine, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, People’s Republic of China; 2Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, People’s Republic of China; 3Department of Assisted Reproduction, Shanghai Ninth People’s Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Yonglun Fu, Department of Assisted Reproductive Medicine, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, 2699 West Gao Ke Road, Shanghai, People’s Republic of China, Tel +86 13917547302, Email fuyonglunivf@163.com Qiaoling Wang, Department of Assisted Reproductive Medicine, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, 2699 West Gao Ke Road, Shanghai, People’s Republic of China, Tel +86 13611767379, Email qiaoling_wang7@163.com
Background: Letrozole is the first-line treatment for ovulation induction in women with polycystic ovary syndrome (PCOS). However, a subset of patients remains anovulatory despite standard treatment, a condition termed “letrozole resistance”. This retrospective cohort study aimed to evaluate the effectiveness and time efficiency of a novel “letrozole stair-step duration regimen”, which skips progestin-induced withdrawal bleeding and proceeds directly to an extended letrozole course after anovulatory cycles, compared with a previously established “ 2-step extended letrozole regimen”.
Methods: We analyzed 158 women with PCOS and letrozole resistance who underwent ovulation induction at two university-affiliated reproductive centers between March 2018 and September 2024. Participants received either the stair-step duration regimen (n = 62) or the 2-step extended regimen (n = 96). Outcomes compared included follicular development, hormone profiles, ovulation, and pregnancy outcomes. The primary outcome was the ovulation rate.
Results: Ovulation rates were comparable between groups [95.16% vs 94.79%]. Clinical pregnancy rates [23.73% (14/59) vs 20.88% (19/91), P = 0.681] and live birth rates [16.95% (11/59) vs 18.68% (17/91), P = 0.824] also showed no significant differences. However, the stair-step group achieved ovulation in a significantly shorter time, with a median of 36 days (interquartile range [IQR] 32– 54) versus 47 days (IQR 45– 51) in the extended regimen group (P < 0.001).
Conclusion: The letrozole stair-step duration regimen is a time-saving and effective ovulation induction protocol for women with PCOS and letrozole resistance, yielding comparable reproductive outcomes in a shorter treatment duration.
Keywords: polycystic ovarian syndrome, ovulation induction, letrozole resistance, letrozole stair-step duration regimen
1Department of Assisted Reproductive Medicine, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, People’s Republic of China; 2Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, People’s Republic of China; 3Department of Assisted Reproduction, Shanghai Ninth People’s Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Yonglun Fu, Department of Assisted Reproductive Medicine, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, 2699 West Gao Ke Road, Shanghai, People’s Republic of China, Tel +86 13917547302, Email fuyonglunivf@163.com Qiaoling Wang, Department of Assisted Reproductive Medicine, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, 2699 West Gao Ke Road, Shanghai, People’s Republic of China, Tel +86 13611767379, Email qiaoling_wang7@163.com
Background: Letrozole is the first-line treatment for ovulation induction in women with polycystic ovary syndrome (PCOS). However, a subset of patients remains anovulatory despite standard treatment, a condition termed “letrozole resistance”. This retrospective cohort study aimed to evaluate the effectiveness and time efficiency of a novel “letrozole stair-step duration regimen”, which skips progestin-induced withdrawal bleeding and proceeds directly to an extended letrozole course after anovulatory cycles, compared with a previously established “ 2-step extended letrozole regimen”.
Methods: We analyzed 158 women with PCOS and letrozole resistance who underwent ovulation induction at two university-affiliated reproductive centers between March 2018 and September 2024. Participants received either the stair-step duration regimen (n = 62) or the 2-step extended regimen (n = 96). Outcomes compared included follicular development, hormone profiles, ovulation, and pregnancy outcomes. The primary outcome was the ovulation rate.
Results: Ovulation rates were comparable between groups [95.16% vs 94.79%]. Clinical pregnancy rates [23.73% (14/59) vs 20.88% (19/91), P = 0.681] and live birth rates [16.95% (11/59) vs 18.68% (17/91), P = 0.824] also showed no significant differences. However, the stair-step group achieved ovulation in a significantly shorter time, with a median of 36 days (interquartile range [IQR] 32– 54) versus 47 days (IQR 45– 51) in the extended regimen group (P < 0.001).
Conclusion: The letrozole stair-step duration regimen is a time-saving and effective ovulation induction protocol for women with PCOS and letrozole resistance, yielding comparable reproductive outcomes in a shorter treatment duration.
Keywords: polycystic ovarian syndrome, ovulation induction, letrozole resistance, letrozole stair-step duration regimen