Comparison of the Effect of Clomiphene- Estradiol Valerate vs Letrozole on Endometrial Thickness, Abortion and Pregnancy Rate in Infertile Women with Polycystic Ovarian Syndrome

Background: The endometrium plays an important role in infertility. The growth of endometrium depends on serum oestradiol level and blood flow to the uterus. A thin endometrium is defined as a lining of less than 7 mm which is associated with infertility. The endometrium is best seen on Transvaginal scan (TVS). The purpose of this study was to evaluate the role of endometrial thickness and its outcome in natural and stimulated cycles in infertile women.Methods: This prospective cohort study was conducted from June 2018 to May 2019 in LLRM Medical College Meerut, Uttar Pradesh, India. Total 150 infertile women of age less than 35 years presented with either primary or secondary infertility were enrolled. Each patient was undergoing transvaginal scan (TVS) to measure endometrial thickness follicular monitoring.Results: The endometrial thickness and pregnancy rate was higher in letrozole induced group as compared to clomiphene with estradiol valerate and clomiphene with sildenafil citrate induced group.Conclusions: Letrozole had better effect on endometrial thickness and pregnancy rate as compared to clomiphene citrate with estradiol valerate and clomiphene citrate with sildenafil citrate.

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COMPARISON OF EFFECT OF CLOMIPHENE CITRATE WITH ESTRADIOL VALERATE V/S LETROZOLE ON PREGNANCY RATE IN INFERTILE WOMEN WITH PCOS

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v4i7.1278 ◽

2020 ◽

Vol 4 (7) ◽

Author(s):

Mendiratta Suman ◽

Joshi Amit Kumar ◽

Netra Harendra Kumar

Keyword(s):

Polycystic Ovary Syndrome ◽

Pregnancy Rate ◽

Polycystic Ovary ◽

Endometrial Thickness ◽

Clomiphene Citrate ◽

Estradiol Valerate ◽

Ovary Syndrome ◽

Infertile Women ◽

Group A ◽

Group B

Background: Polycystic ovary syndrome is the commonest endocrinopathy in anovulatory infertility in young women. It is estimated that infertility affects 10 to 14% of the Indian population of which approximately 25-30% part occupied by PCOS. Methods: This prospective study enrolled 180 infertile women with PCOS, age 21-35 yrs who have taken 1 cycle of clomiphene citrate 100 mg, endometrial thickness <7 mm inspite of follicles greater than 18 mm. Half of them treated with clomiphene citrate with estradiol valerate and remaining half with letrozole. Results: In Group-A treated with clomiphene citrate with estradiol valerate 13 patients (16.3%) conceived and in Group-B treated with letrozole 26 patients (32.5%) conceived. Conclusion: Pregnancy rate is higher in group which treatment with letrozole in comparison with clomiphene citrate plus estradiol valerate. Keywords: Polycystic ovary syndrome, Infertility, Pregnancy rate

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Effect of gonadotropins and endometrial thickness on pregnancy outcome in patients with unexplained infertility or polycystic ovarian syndrome undergoing intrauterine insemination

Journal of International Medical Research ◽

10.1177/0300060520966538 ◽

2020 ◽

Vol 48 (10) ◽

pp. 030006052096653

Author(s):

Qing Li ◽

Maoling Zhu ◽

Zhuxiu Deng ◽

Lihua Wang ◽

Yi Huang ◽

...

Keyword(s):

Pregnancy Rate ◽

Pregnancy Outcome ◽

Polycystic Ovarian Syndrome ◽

Endometrial Thickness ◽

Intrauterine Insemination ◽

Unexplained Infertility ◽

Clinical Pregnancy ◽

Clinical Pregnancy Rates ◽

Ovarian Syndrome ◽

Endometrial Proliferation

Objective The purpose of this study was to investigate the effect of gonadotropin dose and endometrial thickness (EMT) on pregnancy outcome in patients undergoing intrauterine insemination (IUI). Methods We retrospectively analyzed data from 361 patients with unexplained infertility or polycystic ovarian syndrome (PCOS) who underwent 930 IUI cycles treated with gonadotropins. Then, we measured the effects of gonadotropins and EMT on the clinical pregnancy rate. Finally, we assessed the association of various doses of gonadotropins on EMT. Results The dose of gonadotropins given and thickness of the endometrium were higher in the pregnancy group than in the nonpregnancy group (636.0 vs. 600.0 IU for gonadotropin dose; 9.15 vs. 8.70 mm for EMT). Clinical pregnancy rates were significantly improved by increasing the dose of gonadotropins (9.1%, <450 IU; 16.2%, 450–599 IU; 18.6%, 600–749 IU, and 17.3%, ≥750 IU), or by increased EMT (0%, <5.0 mm; 12.2%, 5.0–6.9 mm; 15.5%, 7.0–14.0 mm; and 33.3%, >14.0 mm). Conclusion Increasing the dose of gonadotropins to stimulate one follicle to develop may benefit endometrial proliferation and improve IUI outcomes.

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The Negligible Effect of Metformin Addition to Letrozole in Treating Overweight Women with PCOS

10.52916/jogs204008 ◽

2020 ◽

pp. 1-6

Author(s):

Mohamed Nabih EL-Gharib

Keyword(s):

Menstrual Cycle ◽

Pregnancy Rate ◽

Polycystic Ovarian Syndrome ◽

Endometrial Thickness ◽

University Hospital ◽

Overweight Women ◽

Significant Difference ◽

Group 2 ◽

Ovarian Syndrome ◽

Group 1

Aim: To compare the effects of letrozole alone and letrozole plus metformin on ovulation induction, endometrial thickness, number of ovarian follicles and, the pregnancy rate in overweight, infertile women with the polycystic ovarian syndrome. Study design: Prospective, randomized clinical trial. Material and methods: This study was conducted on 120 patients with polycystic ovarian syndrome, recruited from the infertility clinic of Tanta University Hospital, January 2017 to December 2019. Sixty women were assigned at random to each group. In a group, 1 patient received only daily 5 mg letrozole between days 3 and 7 of the menstrual cycle, and in group 2, continuous metformin was used at the dose of 500mg/TDS/day for three months; afterward, daily 5 mg letrozole between 3 and 7 days of the menstrual cycle was added to the metformin therapy. The patients were treated until pregnancy occurred, or three cycles were reached without pregnancy. Results: There was an insignificant increase in the cumulative pregnancy rate between the metformin-letrazole and the letrazole group. In the metformin-letrozole group, 28.33% of the patents got pregnant, compared with 25% of the patients in the letrazole group. There was no significant difference between the letrazole and the metforminletrazole group regarding ovulation rate, number of the follicle, endometrial thickness, and progesterone level. Conclusion: The addition of metformin to letrazole does not improve the outcome of overweight PCOS women.

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A study of comparison of effectiveness of letrozole (5mg) versus clomephene citrate (100 mg) for ovulation induction among infertile women

Indian Journal of Obstetrics and Gynecology Research ◽

10.18231/j.ijogr.2021.113 ◽

2021 ◽

Vol 8 (4) ◽

pp. 553-558

Author(s):

Manish R Pandya ◽

Khushbu Patel

Keyword(s):

Aromatase Inhibitor ◽

Ovulation Induction ◽

Polycystic Ovarian Syndrome ◽

Clomiphene Citrate ◽

Estradiol Valerate ◽

Infertile Women ◽

Group A ◽

Group B ◽

Ovarian Syndrome ◽

Anovulatory Infertility

Clomiphene citrate has been traditionally used as the drug of the choice for treatment of women with anovulatory infertility. In the last decade, an aromatase inhibitor, letrozole has emerged as an alternative ovulation induction agent among anovulatory women with polycystic ovarian syndrome. Letrozole has a definitive role in anovulatory women who have not responded to the clomiphene citrate therapy is confirmed by literatures. Anovulatory dysfunction is a common problem and is responsible for about 40% of female infertility and among causes; PCOS (polycystic ovarian syndrome) is the leading cause. Clomiphene citrate is considered as the drug of choice for the first line treatment of anovulatory dysfunction for a variety of reasons. Clomiphene citrate has some side effects like multi-follicular development and cyst formation and resistance of clomiphene are areas of concern and desire for an effective alternative persists.An aromatase inhibitor, letrozole, was introduced into infertility practice in the year 2000 and is regarded as a second line option, particularly in women with clomiphene resistance, and it has found acceptance in various clinical situations and the indications for use have expanded., To compare the efficacy of letrozole and clomiphene citrate (CC) for ovulation induction in infertile women. The study included 100 women presented with anovulatory infertility. The infertile women were divided into 2 groups of 50: Group A received 100 mg Clomiphene Citrate from day 3 to day 5 of menstruation and Estradiol Valerate 4 mg on the 12 day of menstruation until 16 day of menstruation; Group B treated by 5 mg Letrozole from day 3 to day 5 of the menstruation and as Group A, Estradiol Valerate 4 mg on the 12 day of menstruation until 16 day of menstruation given to Group B, with visits to determine ovulation and pregnancy, followed by tracking of pregnancies. Participants were of 20 to 39 years age, had normal uterine cavity and had a male partner with a sperm concentration of at least 14 million per millilitre; and during the study the women and their partners agreed to have regular intercourse with the intent of conception. The live birth during the treatment period was the primary outcome. Women who received letrozole had more cumulative live births than those women who had received clomiphene citrate (36 out of 50 [72%] vs. 28 out of 50 [56%]), without significant differences in overall congenital anomalies, there were no congenital anomalies. With letrozole as compared to clomiphene the cumulative ovulation rate was higher. Higher incidence of hot flushes was associated with a clomiphene, and letrozole was associated with fatigue and dizziness. Rates of other adverse effects were almost similar among these 2 groups. A significant difference in the follicular and endometrial development was evident among these 2 groups. As compared to with clomiphene, an aromatase inhibitor, letrozole was associated with higher live-birth and ovulation rates among infertile women. The results of the study demonstrated letrozole to be superior to clomiphene citrate in the maintenance of endometrial thickness.

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Step-up protocol gonadotrophin versus laparoscopic ovarian drilling in clomiphene citrate resistant PCOS infertile women in two Iraqi hospitals

AL-Kindy College Medical Journal ◽

10.47723/kcmj.v15i1.89 ◽

2019 ◽

Vol 15 (1) ◽

pp. 103-109

Author(s):

Thikra N Abdull

Keyword(s):

Pregnancy Rate ◽

Polycystic Ovarian Syndrome ◽

Polycystic Ovary ◽

Transvaginal Ultrasound ◽

Clomiphene Citrate ◽

Multiple Pregnancy ◽

Reproductive Age ◽

Infertile Women ◽

Laparoscopic Ovarian Drilling ◽

Ovarian Syndrome

Background: Polycystic ovarian syndrome is a common endocrine disorder affecting 6-10% of women of reproductive age and the most common cause of anovulatory infertility. Objective: The aim of the study was to compare the effectiveness, side effects and outcomes of step-up gonadotrophin protocol versus laparoscopic ovarian diathermy (LOD) in infertile patients with clomiphene citrate resistant polycystic ovary syndrome. Methods: The sample included women who attended our infertility clinic at Al-Elwiya Maternity Teaching Hospital and Kamal Al-Samarraee for Infertility and IVF Hospital in Baghdad/ Iraq from November 2013 to November 2014. Eighty cases of infertile women with polycystic ovarian syndrome who failed to ovulate with clomiphene citrate for six months where collected, forty women treated with step-up protocol with low dose recombinant FSH gonadotrophin which increased gradually according to ovulation response, another forty women treated with LOD. Ovulation monitoring in each group was done with transvaginal ultrasound to exclude monofollicullar, bifollicular ovulation, ovarian hyperstimulation syndrome, multiple pregnancy and pregnancy rate in each cycle for 6 cycles. Results: Higher unifollicular ovulation and pregnancy rate in LOD than step-up protocol (91.4% & 25% versus 75% & 10%) respectively, while multifollicular and hyperstimulation rate were higher in gonadotrophin group (24.3% & 0.1% versus 8.50% & nil) respectively. Conclusion: Ovulation induction and pregnancy rate per cycle was higher with LOD group, not time consuming, also there was no risk of hyperstimulation of the ovary or twin pregnancy as compared to the step-up protocol with gonadotrophin

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Letrozole or Clomiphene Citrate for Induction of Ovulation in Patients with Polycystic Ovarian Syndrome: A Prospective Randomized Trial

Faridpur Medical College Journal ◽

10.3329/fmcj.v13i2.43641 ◽

2019 ◽

Vol 13 (2) ◽

pp. 78-81

Author(s):

Dilruba Zeba ◽

Rajib Biswas ◽

Kaneez Fatema ◽

Md Abul Khair ◽

Fahmida Zesmin ◽

...

Keyword(s):

Randomized Trial ◽

Pregnancy Rate ◽

Polycystic Ovarian Syndrome ◽

Endometrial Thickness ◽

Clomiphene Citrate ◽

Pcos Patient ◽

Prospective Randomized Trial ◽

Once Daily ◽

Induction Of Ovulation ◽

Ovarian Syndrome

Polycystic Ovarian Syndrome (PCOS) is the most common endocrine disorder responsible for subfertility in young women. The aim of the study was to compare the efficacy of Letrozole over Clomiphene citrate (CC) for ovulation induction in patients with PCOS. It was a prospective randomized trial in a private practice setting. The study period was 3 years, which includes 240 sub fertile patients with PCOS. Patients were divided into two groups. Group-A: 120 patients got Letrozole (2.5 mg) tab, 2 tabs once daily from D2-D6 for 3 cycles. Group-B: 120 patients took tab. Clomiphene citrate (50mg), 2 tabs once daily from D2-D6 for 3 cycles. Trans-vaginal ultrasound was done on D12-D13 to document number of follicles, measurement of dominant follicle and endometrial thickness. Ovulation and pregnancy rate was measured. Results showed that Letrozole have significantly better effect on endometrial thickness (Let 9.2 mm vs CC 8.1mm) and pregnancy rate (Let 44% vs CC 24%). In CC, multiple follicles were found (CC 44% vs Let 30%). Ovulation occurred in 65% with Letrozole group and 64% in CC group without a significant statistical difference. The study concluded that Letrozole have better effect for induction of ovulation in PCOS patient in comparison to CC. Faridpur Med. Coll. J. Jul 2018;13(2): 78-81

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