Comparative Analysis of Effectiveness of Clomiphene Citrate and Letrozole Combined with Low Dose Human Menopausal Gonadotropin for Controlled Ovarian Stimulation in Intrauterine Insemination Cycles
DOI:
https://doi.org/10.33192/Smj.2021.26Keywords:
Clomiphene, letrozole, human menopausal gonadotropin, intrauterine insemination, ovarian stimulationAbstract
Objective: To compare the efficacy of clomiphene citrate and letrozole in combination with low dose human menopausal gonadotropin for controlled ovarian stimulation in intrauterine insemination (IUI) cycles.
Methods: During January-2018 to December-2019 for intending 496 IUI cycles, controlled ovarian stimulation was performed with either clomiphene or letrozole combined with human menopausal gonadotropin (hMG), in two arms: subjects in one arm (Group A) were with clomiphene and hMG in 222 cycles; those in the second arm (Group B) were with letrozole and hMG in 274 cycles. Pregnancy rate and clinical pregnancy rate of both groups were considered as the primary outcomes.
Results: Patient characteristics like female age, indications for IUI, type of IUI, endometrial thickness and total motile fraction (TMF) of spermatozoa of male partners were seen similar in both groups. The letrozole-hMG group (Group B) had significantly higher numbers of cycles with single dominant follicle (P=0.01) and human chorionic gonadotropin (hCG) was more frequently used as the ovulation trigger (P=0.03). Pregnancy rate (18.5% vs. 15.3%, P=0.35) and clinical pregnancy rate (18.5% vs. 15.3%, P=0.35) were similar in groups A and B, respectively.
Conclusion: Clomiphene citrate and letrozole combined with low dose human menopausal gonadotropin were equally effective for controlled ovarian stimulation in IUI cycles.
References
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18. Kamath MS, Bhave P, Aleyamma T, Nair R, Chandy A, Mangalaraj AM, et al. Predictive factors for pregnancy after intrauterine insemination: a prospective study of factors affecting outcome. J Hum Reprod Sci 2010;3(3):129-34.
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21. Badawy A, Elnashar A, Totongy M. Clomiphene citrate or aromatase inhibitors for superovulation in women with unexplained infertility undergoing intrauterine insemination: a prospective randomized trial. Fertil Steril 2009;92(4):1355-1359.
22. Jee BC, Ku SY, Suh CS, Kim KC, Lee WD, Kim SH. Use of letrozole versus clomiphene citrate combined with gonadotropins in intrauterine insemination cycle: A pilot study. Fertil Steril 2006;85:1774-1777
23. Mitwally MF, Casper RF. Aromatase inhibition reduces gonadotrophin dose required for controlled ovarian stimulation in women with unexplained infertility. Hum Reprod 2003;18:1588-1597.
24. Choavaratana R, Malakorn K, Thanaboonyawat I, Petyim S, Laokirkkiat P, Saad N, Prechapanich J. Endometrial thinning after ovarian stimulation using letrozole or clomiphene citrate: A randomized trial. Siriraj Medical Journal 2018; 70:335-342.
2. Amer SA, Smith J, Mahran A, Fox P, Fakis A. Double-blind randomized controlled trial of letrozole versus clomiphene citrate in sub-fertile women with polycystic ovarian syndrome. Hum Reprod 2017; 32(8):1631-1638.
3. Al-Omari WR, Sulaiman W, Al-Hadithi N. Comparision of two aromatase inhibitors in women with Clomiphene resistant polycystic ovary syndrome. Int J Gynecol Obstet 2004;85:289-291.
4. Helena J Teede, Marie L Misso, Michael F Costello, AnujaDokras, JoopLaven, Lisa Moran, TerhiPiltonen, Robert J Norman, International PCOS Network, Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome, Human Reproduction 2018;33(9): 1602-1618.
5. Kamath, MS, Aleyamma, TK, Chandy, A. et al. Aromatase inhibitors in women with clomiphene citrate resistance: a randomized, double-blind, placebo-controlled trial. Fertility and Sterility 2010; 94:2857–2859.
6. Abu Hashim, H, El Rakhawy M, Abd Elaal I. Randomized comparison of superovulation with letrozole vs. clomiphene citrate in an IUI program for women with recently surgically treated minimal to mild endometriosis. Acta Obstet Gynecol Scand 2012;91(3):338-45
7. Eskew AM, Bedrick BS, Hardi A, et al. Letrozole Compared with Clomiphene Citrate for Unexplained Infertility: A Systematic Review and Meta-analysis. Obstet Gynecol 2019;133(3):437-444.
8. Haqnawaz F, Virk S, Qadir T, Imam S, Rizvi J. Comparison of letrozole and clomiphene citrate efficacy alongwith gonadotrophins in controlled ovarian hyperstimulation for intrauterine insemination cycles. J Reprod Infertil 2013;14:138-42
9. Pourali L, Ayati S, Tavakolizadeh S, Soleimani H, Sani FT. Clomiphene citrate versus letrozole with gonadotropins in intrauterine insemination cycles: A randomized trial. Int J Reprod Biomed 2017; 15(1): 49-54.
10. Hembram M, Biswas R, Jain A. A study of controlled ovarian stimulation with clomiphene citrate or letrozole in combination with gonadotropins and IUI in unexplained infertility. J Hum Reprod Sci 2017;10(3):173-177.
11. Kang BM, Wu TC. Effect of age on intrauterine insemination with frozen donor sperm. Obstet Gynecol 1996;88:93-98.
12. Cabry-Goubet R, Scheffler F, Belhadri-Mansouri N, et al. Effect of Gonadotropin Types and Indications on Homologous Intrauterine Insemination Success: A Study from 1251 Cycles and a Review of the Literature. Biomed Res Int 2017;2017:3512784. doi:10.1155/2017/3512784.
13. Soria M, Pradillo G, García J, Ramón P, Castillo A, Jordana C et al. Pregnancy Predictors after Intrauterine Insemination: Analysis of 3012 Cycles in 1201 Couples. J Reprod Infertil 2012;13(3):158-166.
14. Esmailzadeh S, Mahbobeh F. Endometrial thickness and pregnancy outcome after intrauterine insemination. Fertil Steril 2007;88:432–7
15. Weiss NS, Vliet MN, Limpens J, Hompes P, Lambalk C, Mochtar M et al. Endometrial thickness in women undergoing IUI with ovarian stimulation. How thick is too thin? A systematic review and meta-analysis, Human Reproduction 2017; 32(5): 1009-1018.
16. Panda B, Mohapatra L, Sahu M, Padhy RN. Success in pregnancy through intrauterine insemination at first cycle in 300 infertile couples: an analysis. J Obstet Gynaecol India 2014;64:134-42.
17. Dickey RP, Olar TT, Taylor SN, Curole DN, Rye PH. Relationship of follicle number and other factors to fecundability and multiple pregnancies in clomiphene citrate induced intrauterine insemination cycles. Fertil Steril 1992;57(3):613-619.
18. Kamath MS, Bhave P, Aleyamma T, Nair R, Chandy A, Mangalaraj AM, et al. Predictive factors for pregnancy after intrauterine insemination: a prospective study of factors affecting outcome. J Hum Reprod Sci 2010;3(3):129-34.
19. Cantineau AE, Janssen MJ, Cohlen BJ, Allersma T. Synchronized approach for intrauterine insemination in subfertile couples. Cochrane Database Syst Rev 2014;21(12):CD006942
20. Al-Fozan H, Al-Khadouri M, Tan SL, Tulandi T. A randomized trial of letrozole versus clomiphene citrate in women undergoing superovulation. Fertil Steril 2004; 82(6):1561-1563.
21. Badawy A, Elnashar A, Totongy M. Clomiphene citrate or aromatase inhibitors for superovulation in women with unexplained infertility undergoing intrauterine insemination: a prospective randomized trial. Fertil Steril 2009;92(4):1355-1359.
22. Jee BC, Ku SY, Suh CS, Kim KC, Lee WD, Kim SH. Use of letrozole versus clomiphene citrate combined with gonadotropins in intrauterine insemination cycle: A pilot study. Fertil Steril 2006;85:1774-1777
23. Mitwally MF, Casper RF. Aromatase inhibition reduces gonadotrophin dose required for controlled ovarian stimulation in women with unexplained infertility. Hum Reprod 2003;18:1588-1597.
24. Choavaratana R, Malakorn K, Thanaboonyawat I, Petyim S, Laokirkkiat P, Saad N, Prechapanich J. Endometrial thinning after ovarian stimulation using letrozole or clomiphene citrate: A randomized trial. Siriraj Medical Journal 2018; 70:335-342.
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Published
17-02-2021
How to Cite
Thakur, P., & Pradhan, S. (2021). Comparative Analysis of Effectiveness of Clomiphene Citrate and Letrozole Combined with Low Dose Human Menopausal Gonadotropin for Controlled Ovarian Stimulation in Intrauterine Insemination Cycles. Siriraj Medical Journal, 73(3), 198–203. https://doi.org/10.33192/Smj.2021.26
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