Role of Letrozole versus Clomiphene Citrate for Ovulation Induction in Infertile Women
Nahla Ibrahim El-Awady;
Abstract
Infertility is defined as failure to achieve pregnancy after 12 months or more of regular unprotected sexual intercourse (Hochschild et al., 2009).
It has multiple etiologies, however, in approximately 15-17% of couples, no reason for infertility is found and the infertility is defined as unexplained (Gleicher, 2006).
Anovulatory dysfunction is a common problem and is responsible for 40% of all female infertilities. Polycystic ovarian syndrome (PCOS) remains one of its leading causes (Kamath and Goerge, 2011).
Endometriosis is defined as the presence of endometrial-like tissue outside the uterus, which induces a chronic inflammatory reaction. The condition is predominantly found in women of reproductive age, from all ethnic and social groups. Endometriosis plays an important role in female factor infertility (Kennedy et al., 2005).
This study aimed to compare between the effect of clomiphene citrate and Letrazole on ovulation induction in patients with infertility as regards: Number of follicles, endometrial thickness and percentage of pregnancies.
The study was conducted in Ain Shams Maternity Hospital (out-patient infertility clinic).
Patients were divided into two groups with randomization sheet and allocation concealment:
Group (1): includes 50 females taking Letrozole 5 mg tab orally once daily started in day 3 to day 7 of menstrual cycle.
Group (2): includes 50 females taking clomiphene citrate 100 mg tab orally once daily started day 3 to day7 of menstrual cycle.
From the 100 patient included 65 were with PCO diagnosed according to Rotterdam criteria, 14 were with Endometriosis and 21 were with unexplained infertility.
PCO
30 patients with PCO were treated with Letrozole, ovulation rate was 64% and pregnancy rate was 20%. 35 patients were treated with clomiphene citrate, ovulation rate 64.4% and pregnancy rate 14.3%.
Unexplained Infertility
21 patients with unexplained infertility were divided randomly into group A and B. 12 patients received Letrozole 5 mg from day 3 to day 7 of menstrual cycle with total of 36 cycle. The other 9 patients received 100 mg clomiphene citrate from day 3 to day 7 of menstrual cycle with total of 27 cycles. Ovulation rate was 80.5%, 70.4% in group A (Letrozole) and group B (CC) respectively, and pregnancy rate was33.3% and 22.2% respectively.
Endometriosis
16 patients with endometriosis divided randomly, 10 patients received letrozole 5 mg from day 3 to day 7 of menstrual cycle,the total numbers of cycles were 22 cycle.The other 6 patients received Clomiphene citrate 100mg from day 3 to day 7 of menstrual cycle ,total number of cycles was 18 cycle. Ovulation rate was 45.5% and 72.2%, pregnancy rate was 50% and33.3% in letrozole and CC group respectively.
Letrozole can be used also to stimulate ovulation in women who do not respond to CC or in women that have side effects with CC, such as uncomfortable vasomotor symptoms, visual changes, or headaches. These side effects are rare in patients using letrozole for ovulation induction (Nahid & Sirous, 2012). These side effects are rare in patients using letrozole for ovulation induction (Mitwally & Casper, 2001). Some patients will have a thin endometrium (less than 7 mm) when taking CC. The proliferation of the endometrium is stimulated by estrogen. Because CC acts as an estrogen antagonist, in some women the endometrial lining is thin, which may reduce implantation. Letrozole does not have the same antiestrogen effect on the endometrium (Begum et al., 2009).Another advantage of letrozole is that it has a lower incidence of multiple pregnancies when compared with CC or gonadotropins (Mitwally et al., 2005).
It has multiple etiologies, however, in approximately 15-17% of couples, no reason for infertility is found and the infertility is defined as unexplained (Gleicher, 2006).
Anovulatory dysfunction is a common problem and is responsible for 40% of all female infertilities. Polycystic ovarian syndrome (PCOS) remains one of its leading causes (Kamath and Goerge, 2011).
Endometriosis is defined as the presence of endometrial-like tissue outside the uterus, which induces a chronic inflammatory reaction. The condition is predominantly found in women of reproductive age, from all ethnic and social groups. Endometriosis plays an important role in female factor infertility (Kennedy et al., 2005).
This study aimed to compare between the effect of clomiphene citrate and Letrazole on ovulation induction in patients with infertility as regards: Number of follicles, endometrial thickness and percentage of pregnancies.
The study was conducted in Ain Shams Maternity Hospital (out-patient infertility clinic).
Patients were divided into two groups with randomization sheet and allocation concealment:
Group (1): includes 50 females taking Letrozole 5 mg tab orally once daily started in day 3 to day 7 of menstrual cycle.
Group (2): includes 50 females taking clomiphene citrate 100 mg tab orally once daily started day 3 to day7 of menstrual cycle.
From the 100 patient included 65 were with PCO diagnosed according to Rotterdam criteria, 14 were with Endometriosis and 21 were with unexplained infertility.
PCO
30 patients with PCO were treated with Letrozole, ovulation rate was 64% and pregnancy rate was 20%. 35 patients were treated with clomiphene citrate, ovulation rate 64.4% and pregnancy rate 14.3%.
Unexplained Infertility
21 patients with unexplained infertility were divided randomly into group A and B. 12 patients received Letrozole 5 mg from day 3 to day 7 of menstrual cycle with total of 36 cycle. The other 9 patients received 100 mg clomiphene citrate from day 3 to day 7 of menstrual cycle with total of 27 cycles. Ovulation rate was 80.5%, 70.4% in group A (Letrozole) and group B (CC) respectively, and pregnancy rate was33.3% and 22.2% respectively.
Endometriosis
16 patients with endometriosis divided randomly, 10 patients received letrozole 5 mg from day 3 to day 7 of menstrual cycle,the total numbers of cycles were 22 cycle.The other 6 patients received Clomiphene citrate 100mg from day 3 to day 7 of menstrual cycle ,total number of cycles was 18 cycle. Ovulation rate was 45.5% and 72.2%, pregnancy rate was 50% and33.3% in letrozole and CC group respectively.
Letrozole can be used also to stimulate ovulation in women who do not respond to CC or in women that have side effects with CC, such as uncomfortable vasomotor symptoms, visual changes, or headaches. These side effects are rare in patients using letrozole for ovulation induction (Nahid & Sirous, 2012). These side effects are rare in patients using letrozole for ovulation induction (Mitwally & Casper, 2001). Some patients will have a thin endometrium (less than 7 mm) when taking CC. The proliferation of the endometrium is stimulated by estrogen. Because CC acts as an estrogen antagonist, in some women the endometrial lining is thin, which may reduce implantation. Letrozole does not have the same antiestrogen effect on the endometrium (Begum et al., 2009).Another advantage of letrozole is that it has a lower incidence of multiple pregnancies when compared with CC or gonadotropins (Mitwally et al., 2005).
Other data
| Title | Role of Letrozole versus Clomiphene Citrate for Ovulation Induction in Infertile Women | Other Titles | دور الليترازول بالمقارنة بالكلوموفين سيترات في تحريض الإباضة في النساء المصابة بالعقم | Authors | Nahla Ibrahim El-Awady | Issue Date | 2015 |
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