{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,1]],"date-time":"2025-08-01T04:02:29Z","timestamp":1754020949187,"version":"3.41.2"},"reference-count":40,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,2,24]],"date-time":"2022-02-24T00:00:00Z","timestamp":1645660800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100012166","name":"National Key Research and Development Program of China","doi-asserted-by":"publisher","award":["2018YFC1002105"],"award-info":[{"award-number":["2018YFC1002105"]}],"id":[{"id":"10.13039\/501100012166","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To assess the effect of antiandrogenic pretreatment using combined oral contraceptives (COCs) before ovulation induction in infertile patients with polycystic ovary syndrome (PCOS) with hyperandrogenism.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Prospective, randomized open-labeled cohort study<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Multicenter<\/jats:p><\/jats:sec><jats:sec><jats:title>Patients<\/jats:title><jats:p>PCOS patients with hyperandrogenism and requiring infertility treatments<\/jats:p><\/jats:sec><jats:sec><jats:title>Interventions<\/jats:title><jats:p>Randomization to direct ovulation induction of letrozole (letrozole group) or ethinylestradiol\/cyproterone acetate (EE\/CPA) for 3 months and subsequent letrozole-induced ovulation (EE\/CPA+ letrozole group). The maximum number of ovulation induction cycle was three to four.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main Outcome Measures<\/jats:title><jats:p>Ovulation rate, conception rate, ongoing pregnancy rate, and live birth rate were the main outcomes of the study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>There were no significant differences in the cumulative ovulation, conception, ongoing pregnancy, and live birth rates between the letrozole and EE\/CPA+ letrozole groups (cumulative ovulation: 206\/254 [81.10%] <jats:italic>vs<\/jats:italic>. 169\/205 [82.44%], risk ratio [RR]= 1.09 [0.68,1.76], P=0.713; conception: 44\/90 [48.89%] <jats:italic>vs<\/jats:italic>. 42\/76 [55.26%], RR= 1.29 [0.70,2.38], P=0.413; ongoing pregnancy: 33\/90 [36.67%] <jats:italic>vs<\/jats:italic>. 33\/76 [43.42%], RR=1.33 [0.71,2.47], P=0.376; and live birth: 32\/90 [35.56%] <jats:italic>vs<\/jats:italic>. 31\/76 [40.79%], RR=1.25 [0.67, 2.34], P=0.489).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The results of this study showed that COC pretreatment was not superior to direct letrozole-induced ovulation therapy in improving ovulation and pregnancy results in women with PCOS. There is no benefit to perform antiandrogenic therapy before ovulation induction in patients with PCOS in clinical practice.<\/jats:p><\/jats:sec><jats:sec><jats:title>Clinical Trial Registration<\/jats:title><jats:p><jats:uri>www.clinicaltrials.gov<\/jats:uri>, identifier ChiCTR1900022839<\/jats:p><\/jats:sec>","DOI":"10.3389\/fendo.2022.813188","type":"journal-article","created":{"date-parts":[[2022,2,24]],"date-time":"2022-02-24T07:55:36Z","timestamp":1645689336000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["A Randomized Cohort Study: Is It Worth the Time to Receive Antiandrogenic Pretreatment Before Ovulation Induction for Women With Polycystic Ovary Syndrome?"],"prefix":"10.3389","volume":"13","author":[{"given":"Zhiyan","family":"Chen","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jichun","family":"Tan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Huichun","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Beihong","family":"Zheng","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jian","family":"Liu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Guimin","family":"Hao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zaixin","family":"Guo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhengyi","family":"Sun","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qi","family":"Yu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2022,2,24]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cca.2019.11.003","article-title":"Polycystic Ovarian Syndrome: Correlation Between Hyperandrogenism, Insulin Resistance and Obesity","volume":"502","author":"Zeng","year":"2020","journal-title":"Clin Chim Acta"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000002698","article-title":"Polycystic Ovary Syndrome","volume":"132","author":"Azziz","year":"2018","journal-title":"Obstet Gynecol"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1007\/s10815-016-0836-8","article-title":"Female Infertility, Infertility-Associated Diagnoses, and Comorbidities: A Review","volume":"34","author":"Hanson","year":"2017","journal-title":"J Assist Reprod Genet"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2019.00723","article-title":"Assisted Reproduction in Congenital Adrenal Hyperplasia","volume":"10","author":"Chatziaggelou","year":"2019","journal-title":"Front Endocrinol (Lausanne)"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1093\/humupd\/dmv029","article-title":"Pregnancy Complications in Women With Polycystic Ovary Syndrome","volume":"21","author":"Palomba","year":"2015","journal-title":"Hum Reprod Update"},{"key":"B6","doi-asserted-by":"publisher","first-page":"161","DOI":"10.1016\/j.fertnstert.2018.03.028","article-title":"Cognitive-Behavioral Therapy Improves Weight Loss and Quality of Life in Women With Polycystic Ovary Syndrome: A Pilot Randomized Clinical Trial","volume":"110","author":"Cooney","year":"2018","journal-title":"Fertil Steril"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2017.06.026","article-title":"Practice Committee of the American Society for Reproductive Medicine. Role of Metformin for Ovulation Induction in Infertile Patients With Polycystic Ovary Syndrome (PCOS): A Guideline","volume":"108","year":"2017","journal-title":"Fertil Steril"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1093\/humupd\/dmv025","article-title":"Metformin and Lifestyle Modification in Polycystic Ovary Syndrome: Systematic Review and Meta-Analysis","volume":"21","author":"Naderpoor","year":"2015","journal-title":"Hum Reprod Update"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2007.05.035","article-title":"Pretreatment With Oral Contraceptives in Infertile Anovulatory Patients With Polycystic Ovary Syndrome Who Receive Gonadotropins for Controlled Ovarian Stimulation","volume":"89","author":"Palomba","year":"2008","journal-title":"Fertil Steril"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2015-2778","article-title":"Randomized Controlled Trial of Preconception Interventions in Infertile Women With Polycystic Ovary Syndrome","volume":"100","author":"Legro","year":"2015","journal-title":"J Clin Endocrinol Metab"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2018.05.004","article-title":"Recommendations From the International Evidence-Based Guideline for the Assessment and Management of Polycystic Ovary Syndrome","volume":"110","author":"Teede","year":"2018","journal-title":"Fertil Steril"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2012.87802","article-title":"Reporting of Noninferiority and Equivalence Randomized Trials: Extension of the CONSORT 2010 Statement","volume":"308","author":"Piaggio","year":"2012","journal-title":"Jama"},{"key":"B13","doi-asserted-by":"publisher","first-page":"116940","DOI":"10.1016\/j.lfs.2019.116940","article-title":"Hyperandrogenemia and Insulin Resistance: The Chief Culprit of Polycystic Ovary Syndrome","volume":"236","author":"Wang","year":"2019","journal-title":"Life Sci"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2008.06.035","article-title":"The Androgen Excess and PCOS Society Criteria for the Polycystic Ovary Syndrome: The Complete Task Force Report","volume":"91","author":"Azziz","year":"2009","journal-title":"Fertil Steril"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1093\/humupd\/dmp048","article-title":"World Health Organization Reference Values for Human Semen Characteristics","volume":"16","author":"Cooper","year":"2010","journal-title":"Hum Reprod Update"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/dex227","article-title":"Double-Blind Randomized Controlled Trial of Letrozole Versus Clomiphene Citrate in Subfertile Women With Polycystic Ovarian Syndrome","volume":"32","author":"Amer","year":"2017","journal-title":"Hum Reprod"},{"key":"B17","doi-asserted-by":"publisher","first-page":"571","DOI":"10.1016\/j.fertnstert.2018.11.030","article-title":"A Randomized Controlled Trial of Combination Letrozole and Clomiphene Citrate or Letrozole Alone for Ovulation Induction in Women With Polycystic Ovary Syndrome","volume":"111","author":"Mejia","year":"2019","journal-title":"Fertil Steril"},{"key":"B18","article-title":"BMI Classification Percentile And Cut Off Points","volume-title":"StatPearls, StatPearls Publishing Copyright \u00a9 2021","author":"Weir","year":"2021"},{"key":"B19","doi-asserted-by":"publisher","first-page":"444","DOI":"10.1186\/s12889-020-08517-8","article-title":"The Association Between BMI and Health-Related Physical Fitness Among Chinese College Students: A Cross-Sectional Study","volume":"20","author":"Chen","year":"2020","journal-title":"BMC Public Health"},{"key":"B20","doi-asserted-by":"publisher","first-page":"98","DOI":"10.1016\/j.bpobgyn.2016.05.003","article-title":"Androgen Excess: Investigations and Management","volume":"37","author":"Lizneva","year":"2016","journal-title":"Best Pract Res Clin Obstet Gynaecol"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1016\/j.pdpdt.2010.01.003","article-title":"Topical ALA PDT for the Treatment of Severe Acne Vulgaris","volume":"7","author":"Wang","year":"2010","journal-title":"Photodiagnosis Photodyn Ther"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.2337\/dc11-S062","article-title":"Diagnosis and Classification of Diabetes Mellitus","year":"2011","journal-title":"Diabetes Care"},{"key":"B23","doi-asserted-by":"publisher","first-page":"158","DOI":"10.1186\/1471-2288-11-158","article-title":"Selection of the Appropriate Method for the Assessment of Insulin Resistance","volume":"11","author":"Borai","year":"2011","journal-title":"BMC Med Res Methodol"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.4103\/2230-8210.146874","article-title":"Assessment of Insulin Sensitivity\/Resistance","volume":"19","author":"Gutch","year":"2015","journal-title":"Indian J Endocrinol Metab"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1530\/EJE-09-0741","article-title":"Defining Hyperandrogenism in Polycystic Ovary Syndrome: Measurement of Testosterone and Androstenedione by Liquid Chromatography-Tandem Mass Spectrometry and Analysis by Receiver Operator Characteristic Plots","volume":"162","author":"Barth","year":"2010","journal-title":"Eur J Endocrinol"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1016\/j.bpobgyn.2016.08.001","article-title":"Ovulation Induction in Polycystic Ovary Syndrome: Current Options","volume":"37","author":"Legro","year":"2016","journal-title":"Best Pract Res Clin Obstet Gynaecol"},{"key":"B27","doi-asserted-by":"publisher","first-page":"757","DOI":"10.1016\/j.fertnstert.2016.05.022","article-title":"Randomized Controlled Trial of Letrozole, Berberine, or a Combination for Infertility in the Polycystic Ovary Syndrome","volume":"106","author":"Wu","year":"2016","journal-title":"Fertil Steril"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1002\/ijgo.13375","article-title":"Letrozole Versus Clomiphene Citrate for Ovulation Induction in Anovulatory Women With Polycystic Ovarian Syndrome: A Randomized Controlled Trial","volume":"152","author":"Bansal","year":"2021","journal-title":"Int J Gynaecol Obstet"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.16557","article-title":"The Effect of Polycystic Ovary Syndrome Without Hyperandrogenism on Pregnancy-Related Outcomes: A Retrospective Cohort Study","volume":"128","author":"Hu","year":"2021","journal-title":"Bjog"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.1210\/clinem\/dgaa839","article-title":"Update on PCOS: Consequences, Challenges, and Guiding Treatment","volume":"106","author":"Hoeger","year":"2021","journal-title":"J Clin Endocrinol Metab"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2016.10.027","article-title":"Noncontraceptive Use of Oral Combined Hormonal Contraceptives in Polycystic Ovary Syndrome-Risks Versus Benefits","volume":"106","author":"Dokras","year":"2016","journal-title":"Fertil Steril"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000002656","article-title":"American College of Obstetricians and Gynecologists' Committee on Practice Bulletins\u2014Gynecology. ACOG Practice Bulletin No. 194: Polycystic Ovary Syndrome","volume":"131","year":"2018","journal-title":"Obstet Gynecol"},{"key":"B33","doi-asserted-by":"publisher","first-page":"22","DOI":"10.1016\/j.metabol.2017.05.001","article-title":"Effects of Oral Contraceptives on Metabolic Profile in Women With Polycystic Ovary Syndrome: A Meta-Analysis Comparing Products Containing Cyproterone Acetate With Third Generation Progestins","volume":"73","author":"Amiri","year":"2017","journal-title":"Metabolism"},{"key":"B34","doi-asserted-by":"publisher","first-page":"1424","DOI":"10.1067\/mob.2003.459","article-title":"A Randomized Clinical Trial of Treatment of Clomiphene Citrate-Resistant Anovulation With the Use of Oral Contraceptive Pill Suppression and Repeat Clomiphene Citrate Treatment","volume":"188","author":"Branigan","year":"2003","journal-title":"Am J Obstet Gynecol"},{"key":"B35","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2016-1659","article-title":"Benefit of Delayed Fertility Therapy With Preconception Weight Loss Over Immediate Therapy in Obese Women With PCOS","volume":"101","author":"Legro","year":"2016","journal-title":"J Clin Endocrinol Metab"},{"key":"B36","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/deu218","article-title":"Improving the Reporting of Clinical Trials of Infertility Treatments (IMPRINT): Modifying the CONSORT Statement\u2020\u2021","volume":"29","author":"Legro","year":"2014","journal-title":"Hum Reprod"},{"key":"B37","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e31824da35c","article-title":"Endometrial Shedding Effect on Conception and Live Birth in Women With Polycystic Ovary Syndrome","volume":"119","author":"Diamond","year":"2012","journal-title":"Obstet Gynecol"},{"key":"B38","doi-asserted-by":"publisher","DOI":"10.1210\/jc.83.2.582","article-title":"Polycystic Ovary Syndrome: Evidence for Reduced Sensitivity of the Gonadotropin-Releasing Hormone Pulse Generator to Inhibition by Estradiol and Progesterone","volume":"83","author":"Pastor","year":"1998","journal-title":"J Clin Endocrinol Metab"},{"key":"B39","doi-asserted-by":"publisher","first-page":"64","DOI":"10.1080\/13625187.2018.1435779","article-title":"Effects of Combined Oral Contraceptives on the Clinical and Biochemical Parameters of Hyperandrogenism in Patients With Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis","volume":"23","author":"Amiri","year":"2018","journal-title":"Eur J Contracept Reprod Health Care"},{"key":"B40","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1313517","article-title":"Letrozole Versus Clomiphene for Infertility in the Polycystic Ovary Syndrome","volume":"371","author":"Legro","year":"2014","journal-title":"N Engl J Med"}],"container-title":["Frontiers in Endocrinology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2022.813188\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,2,24]],"date-time":"2022-02-24T07:55:39Z","timestamp":1645689339000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2022.813188\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,2,24]]},"references-count":40,"alternative-id":["10.3389\/fendo.2022.813188"],"URL":"https:\/\/doi.org\/10.3389\/fendo.2022.813188","relation":{},"ISSN":["1664-2392"],"issn-type":[{"type":"electronic","value":"1664-2392"}],"subject":[],"published":{"date-parts":[[2022,2,24]]},"article-number":"813188"}}