Discussion
obese, PCOS, OHSS
OBESE, ADVERSE EVENTS, POLYCYSTIC OVARIAN SYNDROME, ADVERSE DRUG REACTIONS, COMPLICATIONS
Our present study in infertile women with PCOS revealed that letrozole 2.5 mg/FSH sequential therapy was superior at ovulation induction and pregnancy rates than letrozole 5 mg/FSH sequential therapy. Specifically, there were no notable disparities in adverse drug reactions.Currently, the majority of frequently used to stimulate ovulation are clomiphene, letrozole, and FSH, with FSH being the most effective and clinically valuable (Letrozole is associated with comparable ovulation rates and reduced rates of complications such as multiple births and OHSS than clomiphene. The 2018 European Society of Human Reproduction and Embryology (ESHRE) “International Evidence-Based Guidelines for the Evaluation and Management of Polycystic Ovarian Syndrome” recommends letrozole as a first-line ovulation induction agent for infertile patients with PCOS (Our recent report suggested that sequential letrozole/gonadotrophin is superior to letrozole alone for inducing ovulation and facilitating pregnancy in infertile women with PCOS (In this study, there was no statistically significant difference in fundamental characteristics between the letrozole 2.5mg/FSH group and the letrozole 5mg/FSH group. However, the incidence of single follicular development was statistically significantly higher in the former group, with a 16.4% absolute difference. Statistically significant improvements were also observed in the biochemical and clinical pregnancy rates in the letrozole 2.5 mg/FSH group. Furthermore, this analysis was stratified by age and body mass index (BMI) (A large BMI is disadvantageous to ovulation in infertile patients with PCOS, and treatment with ovulation-promoting medications is less effective in obese patients than in patients with a normal BMI (We investigate further why the letrozole 2.5 mg/FSH group in this study performed better regarding pregnancy rate. The single mature follicle development rate was significantly higher in the letrozole 2.5 mg/FSH group, suggesting that multiple follicle development is more likely to occur in the letrozole 5 mg/FSH group. It may be because a higher dose of letrozole inhibits the conversion of androgens to estrogens in the body to a greater extent (The benefit of the present research was that, with the exception of the ovulation therapy, there was no disparity between the two groups regarding the other treatments, ranging from pretreatment to dydrogesterone application or the baseline characteristics. Consequently, the two treatment groups are identical at this point. The diagnostic criteria depend on the standard PCOS diagnostic criteria (The present study has limitations that should be acknowledged. This study was open-label, so neither participants nor physicians were uninformed of the medication regimen. However, the patient assignment was determined by a computer-generated randomization algorithm implemented by a statistician who had no responsibility for patient enrolment (Nonetheless, this bias should have a tendency to cause more adverse events in sequential groups, which is contrary to the majority of adverse events observed here. Considering the existence of bias, the actual adverse events of the sequential group should be lower than the current information, which is more advantageous to the present conclusion (