scholarly journals Extended Letrozole Versus Recombinant FSH in Ovulation Induction in Cases of Clomiphene Citrate Resistant Polycystic Ovary

2021 ◽  
pp. 31-39
Author(s):  
Nehad Maher Motit ◽  
Ayman Abdelaziz El-Dorf ◽  
Shahinaz Hamdy Elshourbagy ◽  
Manal Mostafa Abdullah
Keyword(s):  
Ovulation Induction ◽  
Polycystic Ovary ◽  
Endometrial Thickness ◽  
Clomiphene Citrate ◽  
Multiple Pregnancy ◽  
Recombinant Fsh ◽  
Dominant Follicle ◽  
Significance Level ◽  
Significant Difference ◽  
Insignificant Difference

Background: Clomiphene citrate (CC) is still the traditional therapy used for inducing ovulation in polycystic ovary syndrome (PCOS). Clomiphene resistance, which refers to persistence of anovulation after standard CC therapy, occurs in 15%–20% of patients. We aimed to compare between extended letrozole versus recombinant FSH in ovulation induction in cases of clomiphene resistant polycystic ovary Methods: Seventy women with PCOS were included then patients were equally randomized to receive one of the two drugs to be given over the next 3 months. In current study Group A: letrozole group 2.5 mg two tablets once daily for 10 days from day 2 of menses. Group B: Recombinant FSH 75 i.u s.c daily from day 2 for 5 days then monitoring dose according to folliculometry. Results: There was non-significant difference between two groups as regard FSH and LH but as regard Serum E2 (pg/mL) at day 5 of HCG administration there was significant higher in FSH recombinant group. There was insignificant difference between two groups as regard Ovulating, Number of follicles >18. There was insignificant difference between two groups as regard Size of dominant follicle, endometrial thickness at hCG (mm). OHSS, discontinuation due to OHSS, clinical pregnancy, multiple pregnancy and abortion was higher in FSH recombinant group but differences didn’t reach significance. Conclusions: There was non-significant difference between two groups in relation to ovulation, Number of follicles, Size of dominant follicle, Endometrial thickness at day of HCG injection however it was reported that OHSS, discontinuation due to OHSS, positive pregnancy test, was higher in FSH recombinant group but differences didn’t reach significance level.

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

2010 ◽  
Vol 2 (2) ◽  
pp. 169-173
Author(s):  
Randhir Puri ◽  
Ahmed Badawy ◽  
Ibrahim Abdel Aal ◽  
Mohamed Abulatta
Keyword(s):  
Randomized Trial ◽  
Ovulation Induction ◽  
Polycystic Ovary ◽  
Endometrial Thickness ◽  
Clomiphene Citrate ◽  
University Teaching ◽  
Prospective Randomized Trial ◽  
Serum Estradiol ◽  
Serum Progesterone ◽  
Significant Difference

Objective To compare the effects of letrozole (5 mg) and clomiphene citrate (100 mg) for ovulation induction in women with polycystic ovary syndrome (PCOS). Design Prospective randomized trial. Setting University teaching hospital and private practice setting. Patients The study comprised a total of 438 infertile women (1063 cycles) with PCOS. Intervention Patients were randomized to treatment with 5 mg of letrozole daily (218 patients, 545 cycles) or 100 mg of clomiphene citrate daily (220 patients, 518 cycles) for 5 days starting on day 3 of menses. Timed intercourse was advised 24 to 36 hours after hCG injection. Main Outcome Measure Number of follicles, serum estradiol, serum progesterone, endometrial thickness, and pregnancy and miscarriage rates. Results The mean age, parity, and duration of infertility in both groups were similar. The total number of follicles was statistically significantly greater in the clomiphene citrate group (6.8 _ 0.3 vs 4.4 _ 0.4). Endometrial thickness at the time of hCG administration was statistically significantly greater in the CC group (9.2 _ 0.7 mm vs 8.1 _ 0.2 mm). The duration to reach a dominant follicle was statistically significantly longer in the letrozole group (12.1_1.3 vs 8.8_2.9 days). Ovulation occurred in 365 out of 540 cycles (67.5%) in letrozole group and 371 out of 523 cycles (70.9%) without a statistically significant difference. Levels of serum estradiol and progesterone were statistically significantly higher in the clomiphene citrate group. The pregnancy rate per cycle was 15.1% in the letrozole group and 17.9% in the clomiphene citrate group without statistically difference between the groups. Conclusion The results of this study did not show any advantage to the use of letrozole over clomiphene citrate as a first-line treatment for induction of ovulation in women with PCOS (Fertil Steril_2009;92:849-52. _2009 by American Society for Reproductive Medicine).

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

2011 ◽  
Vol 5 ◽  
pp. CMRH.S6598 ◽  
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.

scholarly journals A Review of First Line Infertility Treatments and Supporting Evidence in Women with Polycystic Ovary Syndrome

2019 ◽  
Vol 7 (9) ◽  
pp. 95 ◽  
Author(s):  
Michael Costello ◽  
Rhonda Garad ◽  
Roger Hart ◽  
Hayden Homer ◽  
Louise Johnson ◽  
...  
Keyword(s):  
Polycystic Ovary Syndrome ◽  
Ovulation Induction ◽  
Polycystic Ovary ◽  
Clomiphene Citrate ◽  
Multiple Pregnancy ◽  
Reproductive Age ◽  
Supporting Evidence ◽  
First Line ◽  
Ovary Syndrome ◽  
Ultrasound Monitoring

Polycystic ovary syndrome (PCOS) is the most common cause of anovulatory infertility in women of reproductive age. Lifestyle change is considered the first line treatment for the management of infertile anovulatory women with PCOS, and weight loss for those who are overweight or obese. First line medical ovulation induction therapy to improve fertility outcomes is letrozole, whilst other less efficacious ovulation induction agents, such as clomiphene citrate, metformin, and metformin combined with clomiphene citrate, may also be considered. Metformin combined with clomiphene citrate is more effective than clomiphene citrate alone. In obese women with PCOS, clomiphene citrate could be used in preference to metformin alone whilst clomiphene citrate could be added to metformin alone in order to improve reproductive outcome in all women with PCOS. Gonadotrophins, which are more effective than clomiphene citrate in therapy naïve women with PCOS, can be considered a first line therapy in the presence of ultrasound monitoring, following counselling on the cost and the potential risk of multiple pregnancy.

scholarly journals 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

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]

scholarly journals Endometrial and follicular development following stair-step and traditional protocols in women with polycystic ovary syndrome: An RCT

2021 ◽  
Author(s):  
Sholeh Shahgheibi ◽  
Fariba Seyedoshohadaei ◽  
Danial Khezri ◽  
Solmaz Ghasemi
Keyword(s):  
Polycystic Ovary Syndrome ◽  
Polycystic Ovary ◽  
Endometrial Thickness ◽  
Clomiphene Citrate ◽  
Ovarian Follicles ◽  
Left Ovary ◽  
Ovulation Rate ◽  
Control Group ◽  
Ovary Syndrome ◽  
Significant Difference

Background: Various strategies have been proposed for polycystic ovary syndrome (PCOS) treatment. Objective: To investigate and compare the number and size of ovarian follicles, endometrial thickness, and ovulation rate by traditional protocol (TP) and stair-step protocol (SSP). Materials and Methods: Sixty infertile PCOS women were allocated into two groups (SSP = 30 and control TP = 30) between May and October 2019 in the Besat Hospital, Sanandaj, Iran. In the SSP group, the infertile women were treated with 50 mg/daily clomiphene citrate (CC) for five days, while the nonresponsive women were prescribed 100 mg daily CC for five days in the same cycle. The maximum dose (150 mg) was administered until ovulation occurred. In the control group, in non-ovulatory cases, the dose was increased in the next cycle. Ultrasound was used to detect ovulation. Results: Endometrial thickness changes with various doses of CC were significantly different in the TP. The comparison of both protocols showed a significant difference in endometrial thickness only at 50 mg CC. The number of follicles in the left ovary was significantly different in both protocols at 150-mg CC. The size of ovarian follicles in the left ovary was significantly different between the two protocols at 100-mg CC. The ovulation rate was significantly different in the SSP at 100- and 150-mg doses of CC. Moreover, 86% of ovulation occurred at 100-mg CC in the SSP, while this rate was 73% in the TP. Conclusion: The most appropriate dose for ovulation in patients with PCOS is 100 mg CC. Key words: Polycystic ovary syndrome, Clomiphene, Infertility, Ovulation induction.

scholarly journals Comparative study of clomiphene citrate versus letrozole as first-line ovulation induction drug in infertile polycystic ovary syndrome women

2020 ◽  
Vol 9 (7) ◽  
pp. 2948
Author(s):  
Mahija Sahu ◽  
Nihar Ranjan Rout
Keyword(s):  
Polycystic Ovary Syndrome ◽  
Pregnancy Rate ◽  
Ovulation Induction ◽  
Polycystic Ovary ◽  
Endometrial Thickness ◽  
Clomiphene Citrate ◽  
Ovulation Rate ◽  
First Line ◽  
Ovary Syndrome ◽  
Standard Drug

Background: Polycystic ovary syndrome is the commonest endocrinopathy resulting in anovulatory infertile young women. Clomifene citrate (clomiphene) is a long-standing standard drug for ovulation induction, and is still considered as first line option in PCOS women. However, clomiphene has certain disadvantage letrozole an aromatase inhibitor acts by reducing estrogen production and has no adverse effects on endometrium and cervical mucous. Indian PCOS women have high prevalence of insulin resistance and thus are likely to have high clomiphene resistance. So letrozole could prove to be a good alternative for ovulation induction in such women.Methods: This was a prospective randomized, parallel, comparative clinical trial of two ovulation induction drugs letrozole 5 mg versus clomiphene citrate 100 mg as first-line ovulation induction drug in infertile polycystic ovarian syndrome women. The target population of the study was one hundred infertile women with PCO (taking at least 2 Rotterdam’s parameters). 50 women were allocated to clomifene citrate and 50 were allocated to Letrozole for ovulation induction. Parameters like age, duration of infertility, B MI, ovulation rate, number of follicles, pregnancy rate, endometrial thickness were noted and analyzed.Results: In letrozole group, the ovulation rate, mono-follicular development, mean endometrial thickness and pregnancy rate was better in comparison to clomifene citrate group.Conclusions: The result of this study suggests that letrozole may replace clomiphene as the first line drug for ovulation induction in infertile PCOS women.

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