Factors Influencing Letrozole Response in Ovulation Induction among Polycystic Ovary Syndrome Women dataset
Description
Background: Letrozole is the first-line ovulation induction agent in PCOS, but some women do not respond. This study aimed to evaluate ovulatory response to Letrozole and identify predictors of non-response to individualise treatment. Methods: This retrospective study included women with PCOS (Rotterdam criteria) undergoing their first Letrozole ovulation induction cycle between January 2019 and December 2020. Exclusions were severe male factor infertility, pelvic pathologies, or repeat cycles. Baseline assessments included clinical evaluation, day 3 hormonal profiling (LH, FSH, TSH, Prolactin), and transvaginal ultrasound for antral follicle count (AFC). Letrozole (5 mg/day) was given from day 3 to 7, with follicular monitoring from day 9 to 27. Responders developed ≥1 dominant follicle (≥18 mm), non-responders did not. Data were analysed with Jamovi; logistic regression identified non-response predictors. ROC analysis determined optimal cut-offs (p<0.05 significant). Results: Of 327 women, 186 met criteria. The response rate was 83.3% (155 responders, 31 non-responders). Non-responders had higher BMI, AFC, LH, and LH/FSH ratios. Multivariable regression showed AFC as the only independent predictor of non-response (OR 1.039, 95% CI: 1.003–1.076, p=0.033). ROC analysis identified AFC ≥35 as the optimal cut-off with 61.3% sensitivity, 83.9% specificity, 43.2% PPV, and 91.5% NPV. This indicates women with AFC <35 are more likely to respond to Letrozole. Conclusion: Letrozole induces ovulation in 83.3% of PCOS women. AFC is a key predictor, with <35 indicating better response. Using AFC can reduce failed cycles and guide timely alternative treatments like gonadotropins or IVF.
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Steps to reproduce
Records of women diagnosed with PCOS and treated with Letrozole for ovulation induction were screened. Only the first ovulation induction cycle was included for each participant, as hormonal profiling (LH, FSH, TSH, and Prolactin) was performed during the same cycle in which ovulation induction began.All participants underwent baseline evaluations including: • History and clinical examination: height, weight, BMI, and assessment for hirsutism • Laboratory tests: hemogram, liver and kidney function tests, and day 3 hormone profile (LH, FSH, TSH, Prolactin) • Transvaginal ultrasonography: performed on day 3 to assess for uterine or adnexal masses and to determine antral follicle count (AFC) • For male partners: history and semen analysis were reviewed Menstruation in the subjects could be either spontaneous or progestogen-induced. Day 3 hormone profiling and transvaginal scans were scheduled simultaneously to exclude hormonally active ovarian cysts.The diagnosis of PCOS was made based on the Rotterdam criteria. Letrozole 2.5 mg was administered twice daily (total 5 mg/day) from day 3 to day 7 of the menstrual cycle. Participants were monitored from day 9 onward, every alternate day, up to day 27 using transvaginal ultrasonography to detect follicular growth.• A dominant follicle was defined as one with a diameter ≥18 mm. When such follicles were observed, Inj. hCG 5000 IU was administered at approximately 6 PM on the same day. Responders: Those who developed one or more dominant follicles (≥18 mm) by day 27 of the cycle, Non-responders: Those who did not develop any dominant follicle by day 27. Ovulation was assumed to occur 36 hours after hCG administration, two days after identifying the dominant follicle.
Institutions
- Trivandrum Medical College