scholarly journals Comparative Analysis of Effectiveness of Clomiphene Citrate and Letrozole Combined with Low Dose Human Menopausal Gonadotropin for Controlled Ovarian Stimulation in Intrauterine Insemination Cycles

2021 ◽  
Vol 73 (3) ◽  
pp. 198-203
Author(s):  
Padmalaya Thakur ◽  
Sujata Pradhan
Keyword(s):  
Pregnancy Rate ◽  
Ovarian Stimulation ◽  
Low Dose ◽  
Intrauterine Insemination ◽  
Clomiphene Citrate ◽  
Clinical Pregnancy ◽  
Clinical Pregnancy Rate ◽  
Controlled Ovarian Stimulation ◽  
Human Menopausal Gonadotropin ◽  
Group B

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.

scholarly journals 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

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.

scholarly journals The Study on Different Ovulation Induction Protocols used for Intrauterine Insemination and their Pregnancy Rate in Infertile Couples

2021 ◽  
Vol 10 (11) ◽  
pp. 73-82
Author(s):  
Yaminipriya Devarajlu Dhivya Venkatesan ◽  
Balachandar Vellingiri Ravimanickam Thangarasu ◽  
Sarat Battina
Keyword(s):  
Pregnancy Rate ◽  
Ovulation Induction ◽  
Intrauterine Insemination ◽  
Clomiphene Citrate ◽  
Human Menopausal Gonadotropin ◽  
Fertility Drugs ◽  
Group I ◽  
Significant Difference ◽  
Group B ◽  
Group D

Infertility affects millions of people of reproductive age worldwide and has an impact on their families and communities. Infertility is a disease of male or female reproductive system defined by failure to achieve a pregnancy after 12 months or more of regular unprotected sexual intercourse. Infertility is treated by different fertility drugs, ovulation induction (OI), intrauterine insemination (IUI) and in-vitro fertilization (IVF). The aim of the study is to find out the significant difference in pregnancy rate with different OI protocols used for IUI. OI is the first line treatment given to infertile women. In OI, medications are given to women for egg development and for release of eggs. OI is monitored by follicular study by ultrasonography. Semen is collected from the male partner and processed with culture media to retrieve high motile sperms, which are injected into the uterus of the female. A prospective randomized study was performed among 1343 IUI cycles. OI is started on Day 2 or Day 3 of the menstrual cycle. OI protocol is grouped according to the fertility drugs used for stimulation. The fertility drugs used for the stimulation are Clomiphene Citrate, Letrozole, Recombinant Gonadotropins, Human menopausal Gonadotropins (HMG), Human chorionic Gonadotropin (HCG). Group A uses Clomiphene citrate and HCG, Group B uses Clome, recombinant Gonadotropins and HCG. Group C uses Clome, Human menopausal Gonadotropin and HCG; Group D uses Letrozole and HCG. Group E uses Letrozole recombinant Gonadotropin and HCG. Group F used Letrozole, Human menopausal Gonadotropin and HCG. Group G used recombinant Gonadotropin and HCG. Group H used Human menopausal Gonadotropin and HCG. Group I uses only HCG. Group J was a natural cycle monitoring without any medication and was used as a control. Pregnancy rates were calculated for different age groups with different protocols. The result shows that Group B had 13% pregnancy, Group C had 9%, Group D had 3%, Group E had 10%, Group G had 11%, Group G had 11%, Group H had 7%, Group I had 4%, and Group J had 8% of pregnancy rate. The statistical analysis shows there is no significant difference with different stimulation protocols used.

scholarly journals Relationship between pregnancy rate and number of intrauterine insemination cycles during the study of comparative efficacy of letrozole and clomiphene citrate adjuvants to gonadotropin stimulation in controlled ovarian stimulation cycles combined with intrauterine insemination therapy

2021 ◽  
Vol 11 (1) ◽  
pp. 106
Author(s):  
Pankaj Sharma ◽  
Ashok Verma ◽  
Kritika Katoch
Keyword(s):  
Pregnancy Rate ◽  
Intrauterine Insemination ◽  
Clomiphene Citrate ◽  
Randomized Study ◽  
Good Alternative ◽  
Human Menopausal Gonadotropin ◽  
Male Factor ◽  
Medical College ◽  
Group A ◽  
Group B

Background: Infertility is commonly defined as the failure of conception after at least twelve months of unprotected intercourse. Factors contributing are both male and female in which unexplained etiology accounts for 51%, male factor 28%, endometriosis 17% and ovulatory disorders 4%.Methods: Prospective, randomized study was conducted at DRRPG medical college, Tanda, Kangra, Himachal Pradesh. In our study, patients were randomized into two groups of 30 each. Women in group A received clomiphene citrate 100mg/day and group B received letrozole 2.5 mg/day from day 3-7 of menstrual cycle. All the patients received human menopausal gonadotropin 75 U given every alternate day from day 5 until HCG administration. Ovulation was triggered with recombinant HCG (5000 IUIM) when the dominant follicles reached 18 mm in diameter. A single IUI was performed 36 hours later. A maximum of four cycles were given.Results: In our study, total number of induction cycles given in group A and B were 120 and 114 respectively. Out of these, 112 and 111 IUI cycles were done in group A and B respectively. A pregnancy rate of 1.66% and 7.87% per IUI cycle was observed in group A and B respectively.Thus it is concluded that the pregnancy rates were significantly higher in letrozole group (30%) in comparison to clomiphene citrate group (6.66%).Conclusions: Aromatase inhibitor letrozole appears to constitute a good alternative to clomiphene citrate in patients with unexplained infertility undergoing gonadotropin-stimulated COS cycles combined with IUI therapy.

scholarly journals What is the optimal protocol for Intrauterine Insemination (IUI)? A Mini Review and A Retrospective Study to Evaluate Effective Factors Influencing Pregnancy after IUI

2019 ◽  
Author(s):  
Qing Li ◽  
Belén Herrero ◽  
Mao-Ling Zhu ◽  
Josée Lefebvre ◽  
William Buckett
Keyword(s):  
Logistic Regression ◽  
Pregnancy Rate ◽  
Ovarian Stimulation ◽  
Endometrial Thickness ◽  
Intrauterine Insemination ◽  
Multiple Pregnancy ◽  
Clinical Pregnancy ◽  
Clinical Pregnancy Rate ◽  
Effective Factors ◽  
Optimal Protocol

Abstract Background: Although it is well documented on the study of intrauterine insemination (IUI), the effectiveness of various factors on IUI treatment is inconsistent. The aim of this study is to investigate the various factors that influence IUI outcome and attempt to set up optimal protocol for IUI patients. Methods: This was a retrospective cohort study including1948 cycles (843 couples) that performed IUI between January 2012 and December 2013 in a single centre. Various factors that may affect IUI outcome were analyzed using chi-square. Moreover, we conducted multiple logistic regression to evaluate the main factors on the effects of IUI outcome. In addition, follicle growth and endometrial development relevant to conception were also assessed among protocols. Results: The clinical pregnancy rate (CPR) per cycle was 12.5% in the present study. Seven factors were identified to be associated significantly with CPR by multivariate logistic regression analysis: female age, type of infertility, ovarian stimulation protocol, preovulatory follicles, endometrial thickness, growing length of preovulatory follicle, post-washed total motile spermatozoa count (TMSC). Comparing with 11 days or less, more than 15 days for ovarian response and endometrial development before insemination induced a better success rate. Although ovarian stimulation with gonadotrophin or letrozole induced higher CPR when comparing to stimulation with clomiphene citrate or without stimulation, ovarian stimulation with letrozole was superior to gonadotrophin by its similar CPR to gonadotrophin but lower follicle number, without the risk of multiple pregnancy. Women younger than 41 years with elevated endometrial thickness inseminated with TMSC ≥ 4.0 million had better chance to obtain pregnancy. Number of treatment cycle was not a factor to affect CPR, with a stable CPR in the first four cycles. Conclusions: We conclude that women no more than 41 years old are suitable to perform at least 4 cycles of IUI before proceeding to IVF. The optimized IUI treatment requires ovarian stimulation with letrozole to induce one/two follicles and fertilize with four or more million motile spermatozoa and an elevated endometrium on day 15 or after in the cycle. Key words: infertility, intrauterine insemination, effective factors, clinical pregnancy rate.

Suboptimal response to controlled ovarian stimulation in IVF / ICSI cycles

2021 ◽  
Vol 69 (6) ◽  
pp. 61-70
Author(s):  
Cong Tuan Nguyen ◽  
Dariko A. Niauri ◽  
Lyailya Kh. Dzhemlikhanova ◽  
Igor Yu. Kogan ◽  
Inna O. Krikheli ◽  
...  
Keyword(s):  
Pregnancy Rate ◽  
Ovarian Reserve ◽  
Ovarian Stimulation ◽  
Uterine Fibroids ◽  
Negative Influence ◽  
Clinical Pregnancy ◽  
Clinical Pregnancy Rate ◽  
Controlled Ovarian Stimulation ◽  
Male Factor ◽  
Art Programs

Hypothesis/Aims of study. Currently, the frequency of suboptimal response (4-9 retrieved oocytes) to controlled ovarian stimulation (COS) in woman is quite high; however, its efficacy is poorly studied. The aim of this study was to evaluate the main characteristics of IVF / ICSI programs in patients with a suboptimal response to COS. Study design, materials and methods. We performed a retrospective study of 412 IVF / ICSI cycles in women with a suboptimal response to COS, including a comparative analysis of clinical and embryological parameters, ovarian reserve and the efficacy of IVF / ICSI protocols. Results. Clinical pregnancy rate in ovarian stimulation cycles with a suboptimal response to COS was 27.9%. The efficacy of assisted reproductive technology (ART) programs in women with uterine fibroids was significantly lower than in patients without fibroids (19.1% vs. 30.5%, p = 0.03; OR = 0.54; 95% CI: 0.31-0.95). Clinical pregnancy rate in patients with male factor infertility was significantly higher than in women with anovulation (37.1% vs. 20.9%, р = 0.005; OR = 2.24; 95% CI: 1.27-3.94) or tubal factor infertility (37.1% vs. 24.8%, р = 0.02; OR = 1.79; 95% CI: 1.09-2.94). There were significant correlations between the number of retrieved oocytes with serum anti-Mllerian hormone (AMH) concentration (r = 0.32, p 0.001) and antral follicle count (AFC) (r = 0.38, p 0.001). In addition, the need for follicle-stimulating hormone (FSH) preparations during COS correlated significantly with ovarian reserve parameters (AMH and AFC) (r = 0.45 and 0.44, both p 0.001, respectively) and the age of patients (r = 0.47; p 0.001). Conclusion. The clinical pregnancy rate in women with a suboptimal response to COS was low. Concomitant uterine fibroids represented an additional factor of negative influence on IVF / ICSI outcomes in women with a suboptimal response to COS. The male factor of infertility in patients with a suboptimal response did not reduce the efficacy of ART programs. Ovarian reserve parameters in women with a suboptimal response correlated with the need for FSH preparations during COS and the number of retrieved oocytes.

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

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.

scholarly journals Controlled ovarian stimulation should not be preferred for male infertility treated with intrauterine insemination: a retrospective study

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Yan Tang ◽  
Qian-Dong He ◽  
Ting-Ting Zhang ◽  
Jing-Jing Wang ◽  
Si-Chong Huang ◽  
...  
Keyword(s):  
Ectopic Pregnancy ◽  
Pregnancy Rate ◽  
Ovarian Stimulation ◽  
Intrauterine Insemination ◽  
Multiple Pregnancy ◽  
Clinical Pregnancy ◽  
Male Factor Infertility ◽  
Male Factor ◽  
Ovulatory Follicles ◽  
Multiple Pregnancy Rate

Abstract Background Some studies have stated that intrauterine insemination (IUI) with controlled ovarian stimulation (COS) might increase the pregnancy rate, while others suggest that IUI in the natural cycle (NC) should be the first line of treatment. It remains unclear whether it is necessary to use COS at the same time when IUI is applied to treat isolated male factor infertility. Thus, we aimed to investigate efficacy of IUI with COS for isolated male factor infertility. Methods A total of 601 IUI cycles from 307 couples who sought medical care for isolated male factor infertility between January 2010 and February 2020 were divided into two groups: NC-IUI and COS-IUI. The COS-IUI group was further divided into two subgroups according to the number of pre-ovulatory follicles on the day of HCG: cycles with monofollicular development (one follicle group) and cycles with at least two pre-ovulatory follicles (≥ 2 follicles group). The IUI outcomes, including clinical pregnancy, live birth, spontaneous abortion, ectopic pregnancy, and multiple pregnancy rates were compared. Results The clinical pregnancy, live birth, spontaneous abortion, and ectopic pregnancy rates were comparable between the NC-IUI and COS-IUI group. Similar results were also observed among the NC-IUI, one follicle, and ≥ 2 follicles groups. However, with respect to the multiple pregnancy rate, a trend toward higher multiple pregnancy rate was observed in the COS-IUI group compared to the NC-IUI group (8.7% vs. 0, P = 0.091), and a significant difference was found between the NC-IUI and ≥ 2 follicles group (0 vs. 16.7%, P = 0.033). Conclusion In COS cycles, especially in those with at least two pre-ovulatory follicles, the multiple pregnancy rate increased without a substantial gain in overall pregnancy rate; thus, COS should not be preferred in IUI for isolated male factor infertility. If COS is required, one stimulated follicle and one healthy baby should be the goal considering the safety of both mothers and foetuses.

scholarly journals Discovery and Preclinical Development of Orally Active Small Molecules that Exhibit Highly Selective Follicle Stimulating Hormone Receptor Agonism

2021 ◽  
Vol 11 ◽  
Author(s):  
Selva Nataraja ◽  
Henry Yu ◽  
Joie Guner ◽  
Stephen Palmer
Keyword(s):  
Ovarian Stimulation ◽  
Hormone Receptor ◽  
Ovulation Induction ◽  
Low Dose ◽  
Intrauterine Insemination ◽  
Follicle Stimulating Hormone ◽  
Controlled Ovarian Stimulation ◽  
Orally Active ◽  
Stimulating Hormone

An orally active follicle stimulating hormone receptor allosteric agonist would provide a preferred treatment for over 16 million infertile women of reproductive age in low complexity methods (ovulation induction-intrauterine insemination) or in high complexity methods (controlled ovarian stimulation-in vitro fertilization). We present two oral follicle stimulating hormone receptor allosteric agonist compounds that have the desired pharmacology, drug metabolism, pharmacokinetics, and safety profile for clinical use. These molecules provide a single agent suitable for ovulation induction-intrauterine insemination or controlled ovarian stimulation-in vitro fertilization that is more convenient for patients and achieves similar preclinical efficacy as rec-hFSH. TOP5668, TOP5300 were evaluated in vitro in Chinese hamster ovary cells transfected with individual glycoprotein receptors measuring cAMP (FSHR, LH/CGR, thyroid stimulating hormone receptor). TOP5668 was found to have solely follicle stimulating hormone receptor allosteric agonist activity while TOP5300 was found to have mixed follicle stimulating hormone receptor allosteric agonist and LHR-AA activity. Both compounds stimulated concentration-dependent increases in estradiol production from cultured rat granulosa cells in the presence or absence of low dose rec-hFSH, while only TOP5300 stimulated testosterone production from rat primary Leydig cells. In pooled human granulosa cells obtained from patients undergoing controlled ovarian stimulation-in vitro fertilization, TOP5300 stimulated 7-fold greater maximal estradiol response than rec-hFSH and TOP5668 was 10-fold more potent than TOP5300. Both TOP5300 and TOP5668 stimulated follicular development in immature rat to the same efficacy as recombinant follicle stimulating hormone. In mice treated with TOP5300, in the presence of low dose of follicle stimulating hormone, there were no differences in oocyte number, fertilization rate, and hatched blastocyst rate in mice with TOP5300 and low dose follicle stimulating hormone vs. reference proteins pregnant mare serum gonadotropin or high dose rec-hFSH. ADME/PK and safety profiles were favorable. In addition, there was no appreciable activity on thyroid hormones by TOP5300 in 14-days toxicological study in rat or dog. The selected lead compound, TOP5300 stimulated a more robust increase in estradiol production from granulosa-lutein cells from women with polycystic ovarian syndrome patient compared to rec-hFSH. Conclusions: Two novel oral FSHR allosteric agonist, TOP5668 and TOP5300, were found to mimic the biological activity of rec hFSH in preclinical studies. Both compounds led to folliculogenesis and superovulation in rat and mice. Specifically, TOP5300 led to a similar number of ovulated oocytes that fertilized and developed into hatched blastocysts in mice when compared to rec-hFSH. The safety profile demonstrated lack of toxicity.

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