Effects of letrozole combined with human menopausal gonadotropin in ovarian stimulation for intrauterine insemination cycles

Abstract

The effects of letrozole plus human menopausal gonadotropin (HMG) on ovarian stimulation (OS) of intrauterine insemination (IUI) cycles were examined.Methods: In all, 1,005 IUI cycles were included in this study. Couples underwent natural cycle (NC) IUI (n=150) or IUI after OS with letrozole (n=207) or IUI after OS with letrozole + HMG (n=648).Results: The clinical pregnancy rates were 9.0%, 13.0%, and 17.0%, and the live birth rates were 7.0%, 9.0%, and 14.0% in the NC, letrozole, and letrozole + HMG IUI groups, respectively. The twin pregnancy rate of the letrozole + HMG group (11.0%) was higher than that of the NC (7.0%) and letrozole groups (4.0%). To date, the only triplet pregnancies to occur were in the letrozole + HMG group. On the day of human chorionic gonadotropin (hCG), the number of follicles with an average follicle diameter greater than 18 mm in the letrozole + HMG group (1.21±0.56) and letrozole group (1.14±0.48) was greater than that in the NC group (0.85±0.36). The thickness of the endometrium in the letrozole + HMG group (8.8±2.1 mm) was significantly greater than that in the letrozole group (7.3±1.6 mm). Conclusions:The letrozole + HMG protocol of OS in IUI can improve follicular development, increase the thickness of endometrium, significantly increase the live birth rate, but not significantly increase the multiple pregnancy rate.

Comparison between Letrozole with and without Gonadotropins Injection on Pregnancy Rates in Infertile PCOS Patients: A Multicenter Randomized Observational Trial

“…On the other hand, Chen, et al [28] found that letrozole alone does not significantly reduce the thickness of the endometrium. However, Yu, et al [29] showed that patients that received the combined regimen significantly had thicker endometria than others that received letrozole monotherapy. Another study by Healey, et al [30] reported that letrozole negatively affected the endometrium thickness in a significant relation.…”

Effect of HMG on Pregnancy Outcomes in Patients undergoing IUI Cycle -An Analysis of 1230 IUI Cycles

“…LH was also believed to furnish appropriately estrogenic environment for normal follicular ontogeny, decrease development of small follicles, and optimize dominant follicle selection, alleviating risks of OHSS and multiple pregnancies [19]. Urine human menopausal gonadotropin (HMG), the combination of FSH and LH, is a low-cost and e cient ovulation medicine used in IUI cycles [20]. Earlier initial days and longer usage days of HMG were connected with a higher HMG dose in this study, which was meaningless after adjustment, indicating that HMG dose might be the essential factor in HMG-stimulated IUI cycles.…”

“…The improvement of endometrial proliferation and receptivity, one of the most essential processes in successful mammalian implantation, may be another reason for the association between higher dose, longer days of HMG, and superior outcomes [17]. Many studies have explored the relationship between EMT and pregnancy outcomes in IUI and IVF treatments, but the consensus in the existing studies is inconsistent at best [20,23]. Overall, most literature has shown that better pregnancy outcomes are observed with increasing EMT, which is in line with our results.…”

“…Quaas et al stated a positive association between peak EMT and PR in the setting of gonadotropin cycles with a peak EMT as between 10.5 and 13.9 mm [26]. Another report concerned about 1005 IUI cycles showed an increasing thickness of endometrium and PR in letrozole plus HMG protocol compared with letrozole cycles [20]. However, a multicenter randomized controlled trial manifested that HMG cycles led to a signi cantly thicker endometrium compared to clomiphene citrate in IUI for unexplained subfertility without a consistent association between EMT and ongoing PR [27].…”

Prewash and postwash total progressively motile sperm counts have poor predictive value for clinical pregnancy after intrauterine insemination

“…This discrepancy could be explained by the type of IUI treatment. Several studies [15][16][17] have shown that ovulation induction is an independent variable that usually improves PR of IUI by increasing the number of fertilizable oocytes. In subgroup of women aged 31-35 years, number of stimulated cycles in the TPMSC 10-100 million group (171/355) was statistically significantly lower than in the group with TPMSC over 100 million (297/541, P < 0.001).…”