A Study of Controlled Ovarian Stimulation with Clomiphene Citrate or Letrozole in Combination with Gonadotropins and IUI in Unexplained Infertility

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

Aim:

To compare the effect of clomiphene citrate (CC) + human menopausal gonadotropin (hMG) with letrozole + hMG on size, number of follicles, endometrial thickness, serum levels of oestradiol and progesterone and pregnancy rate.

Settings and Design:

Non-randomised interventional study.

Patients and Methods:

A total number of 60 patients in the age group of 20–35 years with unexplained infertility were divided into two groups, 30 in each. Group A received CC + hMG and group B received letrozole + hMG. In both the groups, ovulation was triggered by hCG followed by intrauterine insemination.

Results:

The number of follicles on day 8 were significantly higher in the CC + hMG group than that in the letrozole + hMG group. Serum oestradiol level was significantly higher in the CC + hMG group on day 10 and on the day of hCG administration. Pregnancy rate in the CC + hMG group was 23.3% and 13.3% in the letrozole + hMG group.

Conclusion:

The sequential protocol was cost-effective. CC + hMG could be a preferred ovarian stimulation protocol in couples with unexplained infertility with the added advantage of having no significant complications in properly monitored cycles.

Related collections

Most cited references 10

Record: found
Abstract: found
Article: not found

A randomized trial of letrozole versus clomiphene citrate in women undergoing superovulation.

Togas Tulandi, Maha Al-Mozaini, Haya Al Farhan … (2004)

To compare the effects of the aromatase inhibitor letrozole (7.5 mg) and clomiphene citrate (CC; 100 mg) in women undergoing superovulation and IUI. Prospective randomized trial. University teaching hospital. We studied a total of 238 cycles of superovulation and IUI in women with idiopathic infertility. Patients were randomized into treatment with 7.5 mg of letrozole daily (74 patients, 115 cycles) or 100 mg of CC daily (80 patients, 123 cycles). Number of follicles, endometrial thickness, pregnancy rate, and miscarriage rate. The mean age, parity, and duration of infertility in both groups of patients were similar. There was no significant difference between the total number of developing follicles in the letrozole (5.7 +/- 3.7) and in the CC groups (4.8 +/- 2.5). The number of follicles of > or =14 mm and of >18 mm were 2.1 +/- 1.2 and 1.4 +/- 0.7 in the letrozole group, and 1.7 +/- 0.9 and 1.1 +/- 0.5 in the CC group, respectively. No difference was found in the endometrial thickness between the two groups (7.1 +/- 0.2 mm in the letrozole group, 8.2 +/- 5.9 mm in the CC group). The pregnancy rate per cycle was 11.5% in the letrozole group and 8.9% in the CC group. Four of the 11 pregnancies in the CC group resulted in a miscarriage (36.6%). Superovulation and IUI with letrozole and CC are associated with similar pregnancy rates, but the miscarriage rate is higher with CC. The ideal dose of letrozole remains unknown and further study is needed.

0 comments Cited 28 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Aromatase inhibition reduces gonadotrophin dose required for controlled ovarian stimulation in women with unexplained infertility.

M F Mitwally, Gail Casper (2003)

Adding clomiphene citrate (CC) to FSH for controlled ovarian stimulation (COS) decreases FSH dose required for optimum stimulation. However, because of its anti-estrogenic effects, CC may be associated with lower pregnancy rates offsetting the FSH-dose reduction benefit. Previously, we reported the success of aromatase inhibition in inducing ovulation without antiestrogenic effects. A prospective pilot study that included women with unexplained infertility undergoing COS and intrauterine insemination. Thirty-six women received the aromatase inhibitor letrozole + FSH, 18 women received CC + FSH and 56 women received FSH only. Each woman received one treatment regimen in one treatment cycle. All patients were given recombinant or highly purified FSH (50-150 IU/day) starting on day 3 to 7 until day of hCG. The FSH dose needed was significantly lower in letrozole + FSH and CC + FSH groups compared with FSH-only without a difference in number of follicles >1.8 cm. Pregnancy rate was 19.1% in the letrozole + FSH group, 10.5% in the CC + FSH group and 18.7% in the FSH-only group. Both pregnancy rate and endometrial thickness were significantly lower in CC + FSH group compared with the other two groups. Estradiol (E2) levels were significantly lower in the letrozole + FSH group compared with the other two groups. Similar to CC, aromatase inhibition with letrozole reduces FSH dose required for COS without the undesirable antiestrogenic effects sometimes seen with CC.

0 comments Cited 26 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Effects of letrozole on superovulation with gonadotropins in women undergoing intrauterine insemination.

Jeff Healey, Marinko Biljan, Andy S L Tan … (2003)

To investigate the effects of letrozole in patients undergoing superovulation with gonadotropins and IUI. Retrospective analysis. Academic teaching hospital. Women younger than 40 years of age with patent fallopian tubes and infertility of more than 1 year in duration who were undergoing IUI and gonadotropin therapy. Gonadotropins alone administered from day 3 or a combination of letrozole, 5 mg/d on day 3 to 7, and gonadotropins starting on day 5 of the menstrual cycle. Ultrasonography was performed before initiation of treatment, on day 9 of menstrual cycle, and as required thereafter until the dominant follicle reached 18 mm in diameter. Ovulation was triggered with 10,000 IU of hCG, and IUI was performed 24 and 48 hours later. Gonadotropin requirements, endometrial thickness, number of follicles, and pregnancy rate. All 205 IUI treatment cycles conducted from March 2001 to March 2002 were included. Gonadotropins alone were used in 145 cycles and combination therapy was used in 60 cycles. Patients cotreated with letrozole required fewer gonadotropin administrations (median difference, 300 IU [95% confidence interval (CI), 225-375 IU]), developed more follicles larger than 14 mm (median difference, 1 follicle [95% CI, 1-2 follicles), and had a thinner endometrium (median difference, 1 mm [95% CI, 0.4-1.6 mm]). The pregnancy rate did not differ between patients using gonadotropin alone and those using gonadotropin plus letrozole (20.9% vs. 21.6%). The addition of letrozole to gonadotropins decreases gonadotropin requirements, increases the number of pre-ovulatory follicles and decreases endometrial thickness, without a negative effect on pregnancy rates.

0 comments Cited 18 times – based on 0 reviews      Review now

Bookmark

All references

Author and article information

Journal

Journal ID (nlm-ta): J Hum Reprod Sci

Journal ID (iso-abbrev): J Hum Reprod Sci

Journal ID (publisher-id): JHRS

Title: Journal of Human Reproductive Sciences

Publisher: Medknow Publications & Media Pvt Ltd (India )

ISSN (Print): 0974-1208

ISSN (Electronic): 1998-4766

Publication date (Print): Jul-Sep 2017

Volume: 10

Issue: 3

Pages: 173-177

Affiliations

[1]Mahatma Gandhi Medical College and Research Institute, Puducherry, India

[1 ]Department of Obstetrics and Gynaecology, Lady Hardinge Medical College and SSKH, New Delhi, India

[2 ]Department of Biochemistry, Lady Hardinge Medical College and SSKH, New Delhi, India

Author notes

Address for correspondence: Dr. Madhusmita Hembram, Mahatma Gandhi Medical College and Research Institute, 3F, Type II Staff Quarters, Puducherry - 607 403, India. E-mail: drmadhusmitahembram@ 123456gmail.com

Article

Publisher ID: JHRS-10-173

DOI: 10.4103/jhrs.JHRS_120_16

PMC ID: 5672722

SO-VID: ac91fbb1-b0e6-4b6d-975a-198b970d943e

License:

This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

A Study of Controlled Ovarian Stimulation with Clomiphene Citrate or Letrozole in Combination with Gonadotropins and IUI in Unexplained Infertility

Read this article at

Abstract

Aim:

Settings and Design:

Patients and Methods:

Results:

Conclusion:

Related collections

The Behavioral Economics of Music: A Framework for the Study of Music Listening, Evaluation, and Choice Behavior

Most cited references 10

A randomized trial of letrozole versus clomiphene citrate in women undergoing superovulation.

Aromatase inhibition reduces gonadotrophin dose required for controlled ovarian stimulation in women with unexplained infertility.

Effects of letrozole on superovulation with gonadotropins in women undergoing intrauterine insemination.

Author and article information

Journal

Affiliations

Author notes

Article

History

Categories

Comments

Comment on this article

Similar content 456

Cited by 2

Most referenced authors 59