Background
Methods
Patient recruitment and counseling
Cycle monitoring and insemination
Outcome parameters
Statistical analysis
Results
Patients
Group I (Natural cycle)
|
Group II (letrozole 2.5 mg)
|
Group III (letrozole 5 mg)
|
P value
| |
---|---|---|---|---|
Total No of patients
| 47 | 125 | 36 | |
Age (Mean
± SD)
| 34.8 ± 5.03 | 33.5 ± 4.02 | 33.88 ± 3.45 | NS |
Day 3 FSH (IU/L)
| 6.01 ± 1.71 | 6.47 ± 2.16 | 7.49 ± 3.76 | I VsII: 0.233 I VsIII: 0.033 |
Total No of cycles started
| 71 | 179 | 50 | |
Completed cycle: No, [%]
| 63 [88.7] | 142 [79.3] | 43 [86] | |
Total number of cycles cancelled: No, [%]
| 8 [11.3] | 37 [20.7] | 7 [14] | 0,06 |
No of monitoring visits (Mean
±SD)
| 2.08 ± 1.02 | 2.3 ± 1.12 | 2.68 ± 1.11 | I VsII: 0.232 I VsIII: 0.003 |
Causes of cycle cancelling
| ||||
Poor responder: No, [%] | 5 [62.5] | 9 [24.3] | 0 [0] | NS |
Ovarian cyst: No, [%] | 0 [0] | 16 [43.2] | 2 [28.6] | NS |
Patient request: No, [%] | 1 [12.5] | 8 [21.6] | 0 [0] | NS |
Elevated FSH: No, [%] | 0 [0] | 2 [5.4] | 3 [42.9] | NS |
Others: No, [%] | 2 [25] | 2 [5.4] | 2 [28.6] | NS |
Indication for IUI
| ||||
Male factor infertility: No, [%] | 38/71 [53.5] | 55/179 [30.7] | 19/50 [38] | NS |
Unexplained infertility: No, [%] | 33/71 [46.5] | 106/179 [59.3] | 30/50 [60] | NS |
Endometriosis: No, [%] | 0 [0] | 9/179 [5] | 0 [0] | NS |
Others No, [%] | 1/71 [1.4] | 9/179 [5] | 1 [2] | NS |
Hormonal dynamics
Estradiol (pmol/mL) | Progesterone (pmol/mL) | LH (IU/L) | |||||||
---|---|---|---|---|---|---|---|---|---|
Group I (Natural cycle) | Group II letrozole 2.5 mg | Group III (letrozole 5 mg) | Group I (Natural cycle) | Group II (letrozole 2.5 mg | Group III (letrozole 5 mg) | Group I (Natural cycle) | Group II (letrozole 2.5 mg | Group III (letrozole 5 mg) | |
D3 | 139.8 ± 66.36 | 154.22 ± 131.31 | 126.71 ± 46.75 | 2.35 ± 0.84 | 2.57 ±.90 | 2.55 ±.89 | 5.18 ± 2.25 | 5.22 ± 3.41 | 5.28 ± 2.71 |
D7 | 257.75 ± 187.8 | 196.60 ± 127.07 | 147.63 ± 69.74 | 2.08 ± 0.40 | 2.37 ± 0.87 | 2.80 ± 0.82 | 5.1 ± 1.34 | 6.71 ± 4.23 | 8.28 ± 4.07 |
D 9-11 | 380.48 ± 238.78 | 810.05 ± 178.26 | 562.53 ± 137.51 | 2.35 ± 0.85 | 2.2 ± 0.79 | 2.67 ± 0.47 | 5.89 ± 2.96 | 5.76 ± 3.30 | 6.65 ± 2.95 |
D hCG | 911.48 ± 941.96 | 1275.41 ± 927.66 | 1066.16 ± 1876.37 | 2.46 ± 1.32 | 2.40 ± 0.89 | 2.75 ± 0.75 | 17.39 ± 16.09 | 8.92 ± 9.86 | 10.50 ± 13.81 |
E2/follicle ≥ 16 mm | 593.12 ± 577.4 | 584.41 ± 1147.84 | 389.8 ± 849.79 |
Follicular dynamics
Group I | Group II | Group III | P value | |
---|---|---|---|---|
Day 3 diameter of follicles in cm
| 0.56 ± 1.02 | 0.79 ± 1.12 | 0.53 ± 0.86 | I vs III: 0.9 |
I vsII: 0.26 | ||||
Number of D 7-8 follicles ≥ 10 mm
| 0.80 ± 0.63 | 2.52 ± 1.37 | 2.23 ± 1.48 | I vs III: 0.000 |
I vsII: 0.000 | ||||
Number of D 9-11follicles more than 12 mm
| 1.13 ± 0.73 | 2.09 ± 1.00 | 2.29 ± 1.35 | I vs III: 0.005 |
I vsII: 0.000 | ||||
Number of mature follicles (≥15 mm) at the Day of hCG
| 1.20 ± 0.48 | 1.84 ± 0.92 | 2.12 ± 0.99 | I vs III: 0.000 |
I vsII: 0.000 |
Endometrial dynamics
Group I | Group II | Group III | |
---|---|---|---|
Cycle day 3
| 0.14 ± 0.26 | 0.10 ± 0.23 | 0.15 ± 0.24 |
Cycle day 7
| 0.55 ± 0.26 | 0.56 ± 0.19 | 0.50 ± 0.19 |
Cycle day 9-11
| 0.65 ± 0.18 | 0.77 ± 0.96 | 0.62 ± 0.16 |
Day of hCG injection
| 0.86 ± 0.16 | 0.82 ± 0.14 | 0.86 ± 0.23 |
Pregnancy rate
Group I Number (%)
|
Combined groups II, III Number (%)
| P value | |
---|---|---|---|
Pregnancy rate/cycle started
| 3/71 (4.2) | 22/229 (9.61) |
0.02
|
Pregnancy rate/cycle completed
| 3/63 (4.8) | 22/185 (11.89) |
0.02
|
Cumulative pregnancy rate
| 3/47 (6.4) | 22/161 (13.7) |
0.01
|
Twin pregnancy
| 0/3 (0) | 3/22 (13.6) |
0.01
|
Miscarriage (No)
| 0/3 (0) | 3/22 (13.6) |
0.01
|
Discussion
Study (reference number) | Intervention | Cohort of patients | Conclusion |
---|---|---|---|
[20] | Letrozole (2.5 mg) Vs CC | Infertile women undergoing Superovulation and IUI. | Similar endometrial thickness and pregnancy rates. |
[21] | letrozole Vs CC as adjuvants to rFSH 41 patients | Superovulation before IUI in unexplained infertility | Better endometrial thickness with letrozole. Similar pregnancy rate |
[22] | Letrozole Vs CC 74 patients | Polycystic ovary syndrome | Similar endometrial thickness and pregnancy rate |
[23] | Letrozole (2.5 mg) Vs CC | Polycystic ovary syndrome | Better endometrial thickness and pregnancy rate with letrozole. |
[24] | Letrozole Vs CC | Polycystic ovary syndrome | No advantage to the use of letrozole over CC as a first-line treatment for induction of ovulation in women with PCOS |
Letrozole Vs CC | Superovulation before IUI in unexplained infertility | No superiority between letrozole and CC for inducing ovulation in women with unexplained infertility before IUI. | |
[27] | Letrozole Vs CC-gonadotropin | Superovulation before IUI in unexplained infertility | Letrozole is a good alternative to CC-gonadotropin. |
[28] | Letrozole (2.5 mg) Vs CC 22 patients | superovulation in women with normal ovulation | CC is superior to 2.5 mg letrozole for superovulation induction in women with normal ovulation. |
[29] | Letrozole (7.5 mg) Vs CC 46 patients | Polycystic ovary syndrome | Letrozole has better ovulation and PR in comparison to CC in patients with PCOS |