Study of endometrial thickness and pregnancy outcome following induction of ovulation and intrauterine insemination in primary infertility

Objective: Infertility affects approximately 10–15% of couples. Assessment of the endometrium with ultrasound has become a standard procedure during the diagnostic workup and treatment of infertility. Our study was designed to investigate whether endometrial thickness on the day of human chorionic gonadotropin administration is a predictor of intrauterine insemination (IUI) success as the primary outcome. Materials and Methods: In the prospective observational study, a serial transvaginal ultrasound scan was performed to measure endometrial thickness following ovulation induction with clomiphene citrate and IUI. One hundred and nine IUI cycles were chosen and the outcome was measured in terms of whether pregnancy occurred or not. Results: There was a statistically significant difference (P = 0.001) between the two groups with respect to mean endometrial thickness (mm). It was also seen significantly higher numbers of pregnancy in Group A (endometrial thickness ≥ 7 mm). Conclusion: The present study identified a statistically significant difference in mean endometrial thickness between cycles that resulted in pregnancy and those did not. Consequently, clinicians providing IUI for infertile couples must pay close attention to endometrial development.

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Letrozole versus Clomiphene Citrate for Induction of Ovulation in Patients with Polycystic Ovarian Syndrome Undergoing Intrauterine Insemination

Clinical Medicine Insights Reproductive Health ◽

10.4137/cmrh.s6598 ◽

2011 ◽

Vol 5 ◽

pp. CMRH.S6598 ◽

Cited By ~ 3

Author(s):

Sherif F. Hendawy ◽

Hanan E. Samaha ◽

Mohamed F. Elkholy

Keyword(s):

Polycystic Ovary ◽

Endometrial Thickness ◽

Intrauterine Insemination ◽

Transvaginal Ultrasound ◽

Clomiphene Citrate ◽

Randomized Study ◽

Multiple Pregnancy ◽

Reproductive Age ◽

Induction Of Ovulation ◽

Significant Difference

Background Polycystic ovary syndrome (PCOS) is one of the most common endocrinopathies affecting women in the reproductive age group, and is one of the most common causes of hyperandrogenic anovulatory infertility. The aromatase inhibitor, letrozole, has been used for induction of ovulation. The purpose of this study was to compare the effects of letrozole and clomiphene citrate in induction of ovulation among patients with PCOS undergoing intrauterine insemination. Methods In a double-blind randomized study, 60 infertile patients with PCOS received standard doses of either clomiphene citrate or letrozole as an induction protocol prior to intrauterine insemination. A hormonal profile, pelvic ultrasound, hysterosalpingogram, and/ or laparoscopy were done for all patients. The patients were monitored for ovulation by translational ultrasonographic folliculometry, with measurement of number and size of the follicles, as well as endometrial thickness. Human chorionic gonadotrophin (HCG) was injected intramuscularly when at least one mature follicle > 18 mm diameter was detected, and intrauterine insemination was performed 32-36 hours later. Transvaginal ultrasound and β-HCG measurement were performed for confirmation of pregnancy. Results Letrozole and clomiphene citrate achieved follicle maturation within a mean ± standard deviation (SD) of 13.2 ± 1.53 and 14.1 ± 1.35 days, respectively, showing no significant difference (P > 0.05). The mean number of follicles reaching >18 mm on the day of HCG administration was significantly higher in patients who received clomiphene citrate (2.9 ± 1.77) than in those receiving letrozole (1.2 ± 0.9). Letrozole had a significantly greater effect than clomiphene citrate on endometrial thickness (9.16 ± 1.36 versus 4.46 ± 1.71). The number of pregnancies achieved in the letrozole group was significantly (P < 0.05) greater than in the clomiphene group. Conclusion Letrozole in patients with PCOS is as effective as clomiphene citrate in inducing ovulation, and although the number of follicles produced by induction with letrozole were less than those produced by clomiphene, letrozole had a significantly greater effect on endometrial thickness than clomiphene citrate, and the incidence of pregnancy after intrauterine insemination was significantly higher, with a lower incidence of multiple pregnancy.

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A study for evaluation of two protocols comprising of clomiphene citrate, human menopausal gonadotropin with or without follicle stimulating hormone for ovulation induction in patients with infertility for intrauterine insemination

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20192455 ◽

2019 ◽

Vol 8 (6) ◽

pp. 2487

Author(s):

Ashok Verma ◽

Shivani Sharma ◽

Suresh Verma ◽

Pankaj Sharma ◽

Tenzin Tsamo Tenga ◽

...

Keyword(s):

Menstrual Cycle ◽

Pregnancy Rate ◽

Ovulation Induction ◽

Endometrial Thickness ◽

Intrauterine Insemination ◽

Clomiphene Citrate ◽

Human Menopausal Gonadotropin ◽

Multiple Gestation ◽

Group A ◽

Group B

Background: To compare two protocols comprising of FSH/CC/HMG and CC/HMG for ovulation induction and IUI in women with infertility.Methods: 60 women with unexplained infertility were randomized using sequentially numbered opaque envelope method. Group A received inj FSH 150 units on day 2 of menstrual cycle and clomiphene citrate 100 mg from day 3-7, followed by injection HMG 150 units on day 9 of menstrual cycle. Group B received clomiphene citrate 100 mg from day 3-7, and HMG 150 units on day 7 and 9 of the menstrual cycle. Ovulation triggered with hCG 5000 units when dominant follicle was 18mm. Single IUI was done 36-42 hours afterwards.Results: Pregnancy occurred in 3 out of 30 women in 116 cycles Group A (with FSH) with a pregnancy rate of 10 percent, and 2.8% per cycle. In group B (without FSH) pregnancy occurred in 3 out of 30 women in 117 cycles with pregnancy rate of 10 percent, and 2.6% per cycle. The number of follicles per cycle was 1.36 and follicle size was 18.57 mm in group A. While in Group B numbers of follicles per cycle were 1.22, with average size of 18.9mm. Mean endometrial thickness was 7.7mm in Group A and 6.37 in Group B (p=.01, significant). Mild OHSS was observed in one woman in Group B. No other side effects were observed in both the groups.Conclusions: The controlled ovarian stimulation regimes used in this study are equally effective, easy to administer, require less intensive monitoring and fewer medications, with little risk of OHSS and multiple gestation.

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Effects of Letrozole-HMG and Clomiphene-HMG on Incidence of Luteinized Unruptured Follicle Syndrome in Infertile Women Undergoing Induction Ovulation and Intrauterine Insemination: A Randomised Trial

Global Journal of Health Science ◽

10.5539/gjhs.v8n4p244 ◽

2015 ◽

Vol 8 (4) ◽

pp. 244 ◽

Cited By ~ 3

Author(s):

Azra Azmoodeh ◽

Mansoureh Pejman Manesh ◽

Firouzeh Akbari Asbagh ◽

Azizeh Ghaseminejad ◽

Zeinab Hamzehgardeshi

Keyword(s):

Menstrual Cycle ◽

Endometrial Thickness ◽

Intrauterine Insemination ◽

Clomiphene Citrate ◽

Randomised Trial ◽

Induction Of Ovulation ◽

Infertile Women ◽

Significant Difference ◽

Preovulatory Follicles ◽

Luteinized Unruptured Follicle

BACKGROUND: Luteinized unruptured follicle (LUF) syndrome is considered a cause of ovulation failure and a subtle cause of infertility. Preovulatory injection of human chorionic gonadotropin (HCG) prevents or treats LUF syndrome, but it has also occurred after the induction of ovulation with clomiphene/HMG and HCG. This study was designed for evaluation and comparison of LUF incidence in eligible infertile women undergoing two stimulation protocols (clomiphene + HMG and letrozole + HMG) in addition to intrauterine insemination (IUI). Some related factors were compared between LUF and non-LUF cycles as secondary outcomes. METHODS: The study was designed as a prospective randomized controlled trial. Patients were randomized using a table of random numbers into two equal protocol groups. For group A, (n = 90) clomiphene citrate was administrated orally in doses of 100 mg/day, and group B (n = 90) orally received letrozole 5 mg/day from day 3 to 7 of the menstrual cycle. Then HMG 75IU/day was administered intramuscularly in both groups on day 8 of the menstrual cycle and the dose was adjusted on the basis of ovarian response. The optimum size of preovulatory follicles for the injection of HCG (10,000 IU) was considered 18–23 mm. The number and size of preovulatory follicles were assessed by vaginal ultrasound 12 h before HCG (D0). Endometrial thickness was measured as well. IUI was performed on all patients 38–40 h after HCG. The second ultrasound examination was performed to observe the evidence of oocyte releasing at the time of IUI (D1). If the follicles were unruptured, a third sonography was performed on day 7 after HCG (D7) to observe LUF syndrome. RESULTS: There was a significant difference between clomiphene-HMG and letrozole-HMG in LUF (p = 0.021) and pregnancy (p = 0.041). The complete LUF in letrozole-HMG was lower than the alternative group and the pregnancy rate was higher. The patients in the non-LUF group had higher midluteal progesterone and a thicker endometrium compared to LUF cycles (p = 0.039) and (p < 0.001). The results of our multivariate logistic regression indicate that size 18–19.9 mm leads to the complete LUF less than ≥22 mm [AOR: 0.25, P = 0.005], and in size 20– 21.9 mm as well [AOR: 0.17, P = 0.002]. CONCLUSION: Letrozole, with lower incidences of LUF, is more effective than clomiphene citrate for the induction of ovulation in IUI cycles. In our study, we illustrated that larger follicles of ≥22 mm diameter were associated with higher incidences of LUF. We recommend that further studies investigate and focus on the relationship between follicular size and/or full hormonal profiles and LUF.

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Effects of Letrozole in Prevention of Premature Luteinizing Hormone (LH) Surge in Infertile Women with Clomiphene Citrate Resistant Polycystic Ovary Syndrome (PCOS) Undergoing Intrauterine Insemination

Galen Medical Journal ◽

10.31661/gmj.v4i3.232 ◽

2015 ◽

Vol 4 (3) ◽

pp. 104-11

Author(s):

Afsoon Zarei ◽

Tahere Bahrami Shabahrami ◽

Nasrin Dadras

Keyword(s):

Luteinizing Hormone ◽

Pregnancy Rate ◽

Polycystic Ovary ◽

Endometrial Thickness ◽

Intrauterine Insemination ◽

Clomiphene Citrate ◽

Control Group ◽

Lh Surge ◽

Significant Difference ◽

Premature Lh Surge

Background: Polycystic ovarian syndrome (PCOS) is among the important causes of infertility in young women. Premature luteinizing hormone (LH) surge (PLS) is one of its complications. PLS can reduce the quality of oocytes and therefore decrease the success of intrauterine insemination (IUI). Letrozole, a non-steroidal aromatase inhibitor, prevents LH surge. In this study, we aim to evaluate the effects of letrozole on preventing premature LH surge in clomiphene-resistant patients with PCOS undergoing IUI. Materials and Methods: In this randomized clinical trial, 131 patients who were developed with PCOS were selected for IUI cycle, divided into two groups randomly: control group (n=67) and letrozole group (n=64). Incidence of premature LH surge, pregnancy, abortion and ongoing pregnancy rate, endometrial thickness and number of follicles were measured in both groups. Results: No significant difference was seen between mean ages in the two groups; 11.9% of the control group and 21.9% of the letrozole group became pregnant (P =0.005); furthermore, premature LH surge was seen in 4.7% of the letrozole group and 8.9% of the control group (P =0.003). E2 and Endometrial thickness was higher in letrozole group; however, LH was significantly higher in the control group (P =0.026). Conclusion: Administration of letrozole in clomiphene-resistant patients with PCO undergoing IUI cycle can decrease the incidence of PLS. In addition, it can increase pregnancy rate significantly. Therefore, using letrozole is more reasonable in patients who have not responded to clomiphene or are hypersensitive. [GMJ.2015;4(3):104-11]

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Role of intrauterine tubo-peritoneal insemination and intrauterine insemination in the treatment of infertility

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20171842 ◽

2017 ◽

Vol 5 (5) ◽

pp. 2057

Author(s):

Disha Gupta ◽

Asha Verma ◽

Richa Gupta ◽

Soniya Saini ◽

Anuradha Salvi ◽

...

Keyword(s):

Pregnancy Rate ◽

Endometrial Thickness ◽

Intrauterine Insemination ◽

Clomiphene Citrate ◽

Positive Outcome ◽

Exclusion Criteria ◽

Significant Difference ◽

Infertile Patients ◽

Urine Pregnancy Test

Background: Infertility management has become more substantial and relevant with an increase in the number of infertile patients as well as advances in the science of reproduction. The objective of our study was to assess the role of intrauterine tuboperitoneal insemination (IUTPI) and intrauterine insemination (IUI) in the treatment of infertile patients.Methods: 236 infertile patients, 118 in each group attending the infertility clinic, after applying both inclusion and exclusion criteria were enrolled in the present study. Patients in each study group were given clomiphene citrate for ovarian stimulation followed by injection hCG for triggering ovulation. Insemination with washed husband’s sperm was performed about 36-40 hours after hCG administration, using 10ml of inseminate in IUTPI and 0.5ml inseminate in IUI. The patient was then called after 2 weeks for urine pregnancy test (UPT) which, if positive was considered as clinical pregnancy.Results: Out of the total 236 cases, 42 cases had a positive outcome. Out of these 42 positive cases, 27 were from IUTPI group whereas 15 from IUI group. The pregnancy rate was 22.88% in IUTPI and 12.71% in IUI (p=0.039), which was a statistically significant difference. Endometrial thickness, preovulatory follicle number and prewash sperm motility significantly affected positive outcome in IUTPI. Factors like patient’s age, BMI<25, bilateral patent tubes and decreased duration of infertility also positively affected the treatment outcome.Conclusions: Our study found IUTPI to have better pregnancy rate compared to IUI. IUTPI may become a first line option for treatment of infertile patients.

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Clinical Outcomes of Tamoxifen and Clomiphene Citrate in Intrauterine Insemination Cycles

International Journal of Infertility & Fetal Medicine ◽

10.5005/jp-journals-10016-1113 ◽

2015 ◽

Vol 6 (3) ◽

pp. 118-121

Author(s):

Asifa Majeed ◽

PS Divyashree

Keyword(s):

Menstrual Cycle ◽

Clinical Outcomes ◽

Endometrial Thickness ◽

Intrauterine Insemination ◽

Transvaginal Ultrasound ◽

Clomiphene Citrate ◽

P Value ◽

Human Menopausal Gonadotropin ◽

Beta Hcg ◽

Retrospective Clinical Study

ABSTRACT Background Both selective estrogen receptor modulators, tamoxifen and clomiphene have been used for ovulation induction for patients with anovulatory infertility. The aim of this study is to compare the effectiveness of tamoxifen to clomiphene on clinical outcome in intrauterine insemination (IUI) cycles. Materials and methods It is a retrospective clinical study. Two hundred and seven women undergoing IUI cycles from July 2013 to July 2014 at Milann—The fertility centre, Bengaluru, India were analyzed. Tamoxifen was administered in the dose of 40 mg starting from day 2/3 of the menstrual cycle for a period of 5 days and clomiphene citrate (CC) was administered in the dose of 100 mg from day 2/3 of menstrual cycle for 5 days. Monitoring of ovulation was done by transvaginal ultrasound from day 5/6 till dominant follicle size was more than 18 mm. Highly purified human chorionic gonadotrophin (hCG) in the dose of 5000 IU was given. Double insemination was done at 24 and 36 hours. Luteal phase support was given in form of dydrogesterone 10 mg twice a day for 14 days. Serum beta-hCG was done after 14 days. Result In our study, 76 patients recieved clomiphene citrate (37%) and 126 patients received tamoxifen (62.9%). Both the groups were comparable in terms of age, period of infertility, FSH, LH, antral follicle count and their human menopausal gonadotropin (hMG) requirement (Table 1). Thirteen patients (23.6%) in CC group and 42 patients (76.4%) in tamoxifen group had positive serum beta hCG result. p-value was found to be significant (p = 0.016) (Table 2). Conclusion Tamoxifen was associated with better endometrial thickness and pregnancy rate when compared to clomiphene citrate in ovarian stimulation in IUI cycles. How to cite this article Majeed A, Divyashree PS, Rao KA. Clinical Outcomes of Tamoxifen and Clomiphene Citrate in Intrauterine Insemination Cycles. Int J Infertil Fetal Med 2015;6(3):118-121.

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Comparison of pregnancy outcome between clomiphene citrate and sequential clomiphene citrate+human menopausal gonadotropin in intrauterine insemination

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20203313 ◽

2020 ◽

Vol 9 (8) ◽

pp. 3302

Author(s):

Ankita Singh ◽

Rohan Palshetkar ◽

Namrata Singh ◽

Awyay Rege

Keyword(s):

Live Birth ◽

Ovarian Stimulation ◽

Endometrial Thickness ◽

Intrauterine Insemination ◽

Clomiphene Citrate ◽

Human Menopausal Gonadotropin ◽

Birth Rates ◽

Cross Sectional ◽

Live Birth Rates ◽

Significant Difference

Background: Intrauterine insemination (IUI) has been widely used as a common treatment for infertile couples. This study compares the sequential clomiphene citrate (CC) treatment with CC and human menopausal gonadotropin (hMG) treatment in women undergoing IUI. Therefore, this study was designed to determine the effects of addition of gonadotropin (CC+hMG) would improve the pregnancy rate in women undergoing IUI. And also compare the sequential CC+hMG treatment with CC treatment in women undergoing IUI.Methods: A cross-sectional study design was conducted at D. Y. Patil Fertility Centre, D.Y Patil Hospital, Navi Mumbai from September 2018 to August 2019. Source populations were all patients who live in Mumbai, Maharashtra, India. A total of 67 patients were enrolled in this study. (It consisted of 67 sub fertile couples undergoing ovarian stimulation for IUI cycles). Results: There was no significant difference between the two studied groups regarding endometrial thickness (8.3±2.1 versus 9.7±2.8, respectively), number of mature follicles on the day of hCG injection (3.3±1.2 versus 3.5±1.1, respectively) and, but there was significant difference between the CC+hMG group and CC group regarding the total dose of gonadotropins used in ovulation induction (305±23.8 versus 655±192; total IU, respectively) p<0.05.Conclusions: Women undergoing IUI, ovarian stimulation CC combined with hMG, significantly improved the pregnancy and live birth rates as compared to that of CC group. In women undergoing ovarian stimulation and IUI, there are no significant differences in pregnancy and live birth rates among the various stimulation protocols.

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Letrozole Versus Clomiphene Citrate for Superovulation in Intrauterine Insemination Cycles - Retrospective Comparative Study Conducted in the Department of Reproductive Medicine, Mahatma Gandhi Medical College & Hospital, Jaipur

Journal of Evolution of Medical and Dental Sciences ◽

10.14260/jemds/2021/408 ◽

2021 ◽

Vol 10 (27) ◽

pp. 1991-1995

Author(s):

Jawahira Chishti ◽

Jai Chowdhary ◽

Archana Paliwal ◽

Chetan Kumar Sharma ◽

Manisha Choudhary

Keyword(s):

Pregnancy Rate ◽

Ovulation Induction ◽

Endometrial Thickness ◽

Intrauterine Insemination ◽

Clomiphene Citrate ◽

Peripheral Tissues ◽

Sperm Density ◽

Estrogen Production ◽

Oral Agents ◽

Significant Difference

BACKGROUND Superovulation with intrauterine insemination (IUI) increases the probability of pregnancy by increasing number of oocytes and sperm density. The main oral agents used for superovulation are clomiphene citrate and letrozole. Clomiphene citrate a selective estrogen receptor modulator with predominant antiestrogenic action has adverse effects on endometrium and cervical mucous. Letrozole an aromatase inhibitor acts by reducing estrogen production by blocking androgen conversion to estrogen in ovary and peripheral tissues without affecting endometrium and cervical mucous. We wanted to compare the efficacy of letrozole v/s clomiphene citrate as first line ovulation induction drug in infertile patients undergoing IUI. METHODS Based on the inclusion and exclusion criteria, we included 160 patients in our study. They were divided into two groups of 80 each based on the drug given for ovulation induction. The drug was given for 5 days from D3 to D7 of menstrual cycle. IUI was done 38 - 40 hours after trigger and after confirmation of ovulation by sonography. RESULTS The mean age, body mass index (BMI), duration of infertility, type and cause of infertility in both groups were similar. Ovulation rate was 85 % in letrozole group and 71.25 % in clomiphene citrate group, which was statistically significant (P0.035). There was no statistically significant difference between endometrial thickness and total days till ovulation between two groups. Monofolliculogenesis and clinical pregnancy rate were statistically significantly higher in letrozole group. CONCLUSIONS Our study shows that letrozole has better pregnancy rate in comparison to clomiphene citrate (C. C.) in IUI cycles with less risk of anovulation, thin endometrium and multi follicular growth. KEY WORDS Clomiphene Citrate (C.C.), Letrozole (LTZ), Ovulation Induction (OI), Intrauterine Insemination (IUI)

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STUDY FOR EVALUATION OF COMPRISING OF CLOMIPHENE CITRATE, HUMAN MENOPAUSAL GONADOTROPIN WITH OR WITHOUT FOLLICLE STIMULATING HORMONE FOR OVULATION INDUCTION IN PATIENTS WITH INFERTILITY FOR INTRAUTERINE INSEMINATION AT NMCH, JAMUHAR, SASARAM, BIHAR

10.36106/ijsr/1638275 ◽

2021 ◽

pp. 30-32

Author(s):

Smriti Sinha ◽

Rita Sinha ◽

Debarshi Jana

Keyword(s):

Menstrual Cycle ◽

Pregnancy Rate ◽

Ovulation Induction ◽

Endometrial Thickness ◽

Intrauterine Insemination ◽

Clomiphene Citrate ◽

Human Menopausal Gonadotropin ◽

Multiple Gestation ◽

Group A ◽

Group B

Background: To compare two protocols comprising of FSH/CC/HMG and CC/HMG for ovulation induction and IUI in women with infertility. Methods: 60 women with unexplained infertility were randomized using sequentially numbered opaque envelope method. Group A received inj FSH 150 units on day 2 of menstrual cycle and clomiphene citrate 100 mg from day 3 - 7, followed by injection HMG 150 units on day 9 of menstrual cycle. Group B received clomiphene citrate 100 mg from day 3-7, and HMG 150 units on day 7 and 9 of the menstrual cycle. Ovulation triggered with hCG 5000 units when dominant follicle was 18mm. Single IUI was done 36-42 hours afterwards. Results: Pregnancy occurred in 3 out of 30 women in 116 cycles Group A (with FSH) with a pregnancy rate of 10 percent, and 2.8% per cycle. In group B (without FSH) pregnancy occurred in 3 out of 30 women in 117 cycles with pregnancy rate of 10 percent, and 2.6% per cycle. The number of follicles per cycle was 1.36 and follicle size was 18.57 mm in group A. While in Group B numbers of follicles per cycle were 1.22, with average size of 18.9mm. Mean endometrial thickness was 7.7mm in Group A and 6.37 in Group B (p=.01, signicant). Mild OHSS was observed in one woman in Group B. No other side effects were observed in both the groups. Conclusions: The controlled ovarian stimulation regimes used in this study are equally effective, easy to administer, require less intensive monitoring and fewer medications, with little risk of OHSS and multiple gestation.

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