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. 2015 Apr-Jun;9(1):17-26.
doi: 10.22074/ijfs.2015.4204. Epub 2015 Apr 21.

A Randomized Clinical Trial on Comparing The Cycle Characteristics of Two Different Initiation Days of Letrozole Treatment in Clomiphene Citrate Resistant PCOS Patients in IUI Cycles

Nayereh Ghomian  1 , Ashraf Khosravi  1 , Nezhat Mousavifar  1
Affiliations

A Randomized Clinical Trial on Comparing The Cycle Characteristics of Two Different Initiation Days of Letrozole Treatment in Clomiphene Citrate Resistant PCOS Patients in IUI Cycles

Nayereh Ghomian et al. Int J Fertil Steril. 2015 Apr-Jun.

Abstract

Background: There are still many questions about the ideal protocol for letrozole (LTZ) as the commonest aromatase inhibitor (AI) used in ovulation induction. The aim of this study is to compare the ultrasonographic and hormonal characteristics of two different initiation times of LTZ in clomiphene citrate (CC) failure patients and to study androgen dynamics during the cycle.

Materials and methods: This randomized clinical trial was done from March to November 2010 at the Mashhad IVF Center, a university based IVF center. Seventy infertile polycystic ovarian syndrome (PCOS) patients who were refractory to at least 3 CC treatment cycles were randomly divided into two groups. Group A (n=35) receiving 5 mg LTZ on cycle days 3-7 (CD3), and group B (n=35) receiving the same amount on cycle days 5-9 (CD5). Hormonal profile and ultrasonographic scanning were done on cycle day 3 and three days after completion of LTZ treatment (cycle day 10 or 12). Afterward, 5,000-10,000 IU human chorionic gonadotropin (hCG) was injected if at least one follicle ≥18 mm was seen in ultrasonographic scanning. Intrauterine insemination (IUI) has been done 36-40 hours later. The cycle characteristics, the ovulation and pregnancy rate were compared between two groups. The statistical analysis was done using Fisher's exact test, t test, logistic regression, and Mann-Whitney U test.

Results: There were no significant differences between two groups considering patient characteristics. The ovulation rate (48.6 vs. 32.4% in group A and B, respectively), the endometrial thickness, the number of mature follicles, and length of follicular phase were not significantly different between the two groups.

Conclusion: LTZ is an effective treatment in CC failure PCOS patients. There are no significant differences regarding ovulation and pregnancy rates between two different protocols of LTZ starting on days 3 and 5 of menstrual cycle (

Registration number: IRCT201307096467N3).

Keywords: Clomiphene Citrate; Letrozole; Polycystic Ovarian Syndrome (PCOS).

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Figures

Fig.1
Fig.1
PCOS; Polycystic ovary syndrome, CC; Clomiphene citrate, E2; Estradiol , LTZ; Letrozole, hCG; Human chorionic gonadotropin and IUI; Intrauterine insemination.
See this image and copyright information in PMC

References

    1. Badawy A, Mosbah A, Tharwat A, Eid M. Extended letrozole therapy for ovulation induction in clomipheneresistant women with polycystic ovary syndrome: a novel protocol. Fertil Steril. 2009;92(1):236–239. - PubMed
    1. Casper RF, Mitwally MF. Review: aromatase inhibitors for ovulation induction. J Clin Endocrinol Metab. 2006;91(3):760–771. - PubMed
    1. Franks S, Adams J, Mason H, Polson D. Ovulatory disorders in women with polycystic ovary syndrome. Clin Obstet Gynaecol. 1985;12(3):605–632. - PubMed
    1. Bhatnagar AS, Hausler A, Schieweck K, Lang M, Bowman R. Highly selective inhibition of estrogen biosynthesis by CGS 20267, a new non-steroidal aromatase inhibitor. J Steroid Biochem Mol Biol. 1990;37(6):1021–1027. - PubMed
    1. Polyzos NP, Tzioras S, Badawy AM, Valachis A, Dritsas C, Mauri D. Aromatase inhibitors for female infertility: a systematic review of the literature. Reprod Biomed Online. 2009;19(4):456–471. - PubMed

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