A Prospective, Randomized, Comparative Clinical Study of the efficacy of Letrozole and Clomiphene Citrate as adjuvants to Follicle-Stimulating hormone in Superovulation

Document Type : Original Article

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Obstetrics and Gynecology Department , Menofiya University, Egypt

Abstract

Objective: To compare the efficacy of the aromatase inhibitor letrozole and clomiphene
citrate (CC) as adjuvants to follicle-stimulating hormone (FSH) in superovulation.
Materials & Methods: A total of 120 patients with unexplained or mild male factor infertility were randomized to receive either letrozole or CC as adjuvants to FSH. From day
3 to 7 of the cycle 2.5 mg/d letrozole or 100 mg/d CC were administered followed by 75
IU/d FSH starting on day 7 until the day of human chorionic gonadotropin (hCG). Ovulation was triggered with 10,000 IU of hCG when the leading follicle (s) reached 18 mm
in diameter. A single intrauterine insemination (IUI) was performed 36 h later. Ovarian
(estradiol (E2) levels and number of follicles) and endometrial (endometrial thickness)
response and pregnancy outcome were the main measures.
Results: The number of mature preovulatory follicles (1.9 + 0.7 vs. 2.2 + 0.5, P<0.0001)
and the peak E2 level (791 + 163 vs. 1137 + 192 pg/ml, P<0.0001) were significantly
higher in the CC group than in the letrozole group. A significantly higher endometrial
thickness was observed on the day of hCG in the letrozole group (9.1 + 1.2 vs. 7.7 + 1.4
mm, P<0.0001). There was no significant difference between groups in clinical pregnancy rates (38.4% in the letrozole and 31.3% in the CC groups).
Conclusions: The aromatase inhibitor letrozole appears to be a good alternative to CC
in superovulation therapy.

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