The Clinical Research Of Letrozole On The Treatment Of Ovarion Hyperstimulation Syndrome

Objective1.To assess the efficacy of letrozole with other medicine in decreasing the ovarian hyperstimulation syndrome(OHSS)occurrence during the luteal phase for patients of OHSS high—risk after oocyte retrieval.2.To identify whether the serum IL-6,IL-8 and TNF-a level in patients with OHSS high-risk was higher and the tendency of these vasoactive substances after using drugs.Methods The participants were recruited from the Reproductive Medicine Center of Our Hospital,from January 2016 to October 2016.The participants were potentially eligible for the trial if they were at high risk of developing OHSS after oocyte retrieval,Then these participants were randomly divided into four groups according to administration of different medicine after oocyte retrieval.Group A(n = 38)received: Gn RH-A +HES+calcium per day for 5 consecutive days beginning on the day after oocyte retrieval.Group B(n = 39): received letrozole + HES+calcium per day for 5 consecutive days beginning on the day after oocyte retrieval;Group C(n = 39): received HES+calcium per day for 5 consecutive days beginning on the day after oocyte retrieval;Group D(n =40): received bromocriptine+HES+calcium per day for 5 consecutive days beginning on the day after oocyte retrieval.Then the volume of ovarian?sex hormone levels(follicle stimulating hormone?luteinizing hormone?estradiol and progestogen),vasoactive substances(IL-6,IL-8 and TNF-a levels),white blood cell,hematocrit in all patients were measured on the day of oocyte retrieval,the second,the fourth,and the sixth days after after oocyte retrieval in the each groups respectively.In orderd to compare the incidences of moderate and severe OHSS between different treatment groups.This study was approved by the Ethics Committee of the first Affiliated Hospital of Anhui Medical University and all patients had signed the informed consent.Results(1)Serum E2 levels at 2,4,6 days after oocyte retrieval among the four groups Compared with other groups,the levels of E2 on days 2 after oocyte retrieval in group B is was significantly lower than group A,group D(2988.79±302.83 pmol/l vs4537.95±435.39 pmol/l vs 4938.23±386.23 pmol/l vs 4832.40±334.67 pmol/l)(p< 0.05);At the same time,the levels of E2 on days 4,days 6 after oocyte retrieval in group B were also significant lower than group A,group C,group D(d4:2532.3±177.08 pmol/l vs 10095.82±655.59 pmol/l vs 7951.08±671.46 pmol/l vs 9702.68±702.16 pmol/l;d6:933.69±97.91 pmol/l vs 7494.13±742.23 pmol/l vs 4468.69±448.77 pmol/l vs8266.12±722.99 pmol/l)(p< 0.05).(2)The relationship between E2 on day 2,4,6 after oocyte retrieval and the severity of OHSS Serum E2 levels on day 2,4,6 after oocyte retrieval were significantly higher in the moderate/severe OHSS subgroup than in the mild OHSS subgroup(d2:5107.22±333.50 vs 3782.93±213.02;d4: 10491.38±625.38 vs 5534.29±346.20;d6: 8152.62±645.58 vs 3308.12±276.87)(p<0.05).(3)Serum cytokines at 2,4,6 days after oocyte retrieval among the four groups Then the datasets of serum vasoactive substances levels were analyzed at the same time on days 2,4,and 6 after oocyte retrieval between four groups,the results showed that the levels of serum IL-6?IL-8 on day 2 after oocyte pick-up have no significant between these groups(IL-6: p=0.160;IL-8: p=0.076),while the serum IL-6 on day 4 after oocyte retrieval was obviously lower in group B than group Cand group D(14.69±1.20 vs20.05±1.46 vs 21.10±2.07,p<0.05).The serum IL-8 on day 4 after oocyte retrieval was also statistically significant lower in group B than group A and group D(17.54±1.72 vs25.55±2.24 vs 28.94±3.07,p<0.05).There have no significant on serum IL-6?IL-8?TNF-a on day 6 after oocyte retrieval among group A,group B,group C,group D(p>0.05).(4)The outcomes of OHSS among the four groups Then we further analyzed the relationship between E2 on day 2,4,6 after oocyte retrieval and the severity of OHSS.In four groups,There were 19 cases of mild OHSS,9 cases of moderate,10 cases of severe OHSS in the group A,and 20 cases of mild OHSS,10 cases of moderate,9 cases of severe OHSS in the group C,and 22 cases of mild OHSS,9 cases of moderate,9 cases of severe OHSS in the group D,while in group B,33 cases of mild OHSS,4 cases of moderate,2 cases of severe OHSS in the group B,This indicated the incidence of moderate and severe OHSS was signicantly decreased after letrozole treatment compared with other treatment groups(p <0.05).Conclusion Our results indicate that luteal letrozole administration significantly decrease serum estradiol levels and more effective than others treatments in decreasing the incidence of moderate and severe early-onset ovarian hyperstimulation syndrome in high risk women.This provide a new treatment for ovarian hyperstimulation syndrome.