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. 2015 Mar;56(2):490-6.
doi: 10.3349/ymj.2015.56.2.490.

Minimal stimulation using gonadotropin combined with clomiphene citrate or letrozole for intrauterine insemination

Bo Hyon Yun  1 , Seung Joo Chon  1 , Joo Hyun Park  2 , Seok Kyo Seo  1 , SiHyun Cho  2 , Young Sik Choi  3 , Seok Hyun Kim  4 , Byung Seok Lee  1
Affiliations

Minimal stimulation using gonadotropin combined with clomiphene citrate or letrozole for intrauterine insemination

Bo Hyon Yun et al. Yonsei Med J. 2015 Mar.

Abstract

Purpose: To evaluate the efficacy of minimal stimulation using discretely administered gonadotropin combined with clomiphene citrate (CC) or letrozole (LTZ) for intrauterine insemination (IUI) cycles.

Materials and methods: Total 257 IUI cycles from 158 infertile couples were assessed. A CC dose of 100 mg/day (n=126 cycles) or a LTZ dose of 5 mg/day (n=131 cycles) was administered on days 3-5 of the menstrual cycle for 5 days. Each group received human menopausal gonadotropin at a dose of 150 IU by two or three alternative day: CC combined with alternate-day regimen for 2 or 3 days (CC+300, n=37; CC+450, n=89) and LTZ combined with alternate-day regimen for 2 or 3 days (LTZ+300, n=36; LTZ+450, n=95).

Results: The clinical pregnancy rate was comparable between the CC and LTZ groups (18.3% vs. 13.0%, p=0.243). The clinical pregnancy rate also showed no significant difference among the 4 groups (21.6% vs. 16.9% vs. 11.1% vs. 12.6%, p=0.507). The multiple pregnancy rate was significantly higher in LTZ compared to CC group (37.5% vs. 8.7%, p=0.028) and in the LTZ+450 compared to CC+450 group (50% vs. 13.3%, p=0.038). Overall, there were 15 cases of ovarian hyperstimulation syndrome (OHSS), with the prevalence being significantly lower in the LTZ compared to CC group (1.5% vs. 10.3%, p=0.003). OHSS was more prevalent in the CC+450 compared to the LTZ+450 group (12.4% vs. 1.1%, p=0.002).

Conclusion: Our findings suggest that minimal stimulation using two alternate-day gonadotropin with LTZ decreases the development of OHSS and multiple pregnancies, while maintaining comparable pregnancy rates in IUI cycles.

Keywords: Intrauterine insemination; clomiphene citrate; gonadotropin; letrozole; minimal stimulation.

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Conflict of interest statement

The authors have no financial conflicts of interest.

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