Endometrial thickness after ovarian stimulation with gonadotropin, clomiphene, or letrozole for unexplained infertility, and association with treatment outcomes

Quaas, Alexander; Gavrizi, Sarah Z.; Peck, Jennifer D.; Diamond, Michael P.; Legro, Richard S.; Robinson, Randal D.; Casson, Peter R.; Christman, Gregory M.; Zhang, Heping; Hansen, Karl R.

doi:10.1016/j.fertnstert.2020.07.030

Cited by 32 publications

(26 citation statements)

References 37 publications

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“…A systematic review and meta-analysis in 2019 showed no difference in terms of clinical pregnancy, live birth, spontaneous miscarriage, or twin gestation between letrozole and CC for unexplained infertility (43). A Multicenter randomized controlled trial in 2020, showed that gonadotropin, clomiphene, or letrozole reached the same pregnancy outcomes (44). However, a study by Usama M Fouda et al indicated that the extended letrozole regimen had a significantly greater pregnancy rate per cycle and cumulative pregnancy rate than CC in unexplained infertility patients underwent superovulation combined with IUI (42).…”

Section: Letrozole For Unexplained Infertilitymentioning

confidence: 99%

Section: Letrozole For Unexplained Infertilitymentioning

confidence: 99%

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Letrozole for Female Infertility

et al. 2021

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Letrozole, an aromatase inhibitor that blocks estrogen synthesis by inhibiting the final step of the estrogen biosynthetic pathway, has been used in the applications of a wide range of infertility settings. It has been more than 20 years since the initial clinical trial of letrozole for ovulation induction. In light of the accumulating clinical and basic evidence, the efficacy and safety of letrozole have been identified. This mini review focuses on our current knowledge of the applications and mechanisms of letrozole for female infertility and various questions are put forward about how letrozole could be more effectively used.

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Section: Letrozole For Unexplained Infertilitymentioning

confidence: 99%

Section: Letrozole For Unexplained Infertilitymentioning

confidence: 99%

Letrozole for Female Infertility

et al. 2021

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“…Quaas et al examined both the effect of stimulation protocol on endometrial thickness and whether endometrial thickness in these cycles was associated with live birth rates. 34 Accordingly, higher live births were observed with increasing endometrial thickness, but the relation was nonsignificant when adjusted for ovulation induction agents. 34 In line with these studies, we observed no significant difference between pregnant and nonpregnant patients regarding the endometrial thickness.…”

Section: Discussionmentioning

confidence: 96%

The strain rate of endometrium measured by real‐time sonoelastography as a predictive marker for pregnancy in gonadotropin stimulated intrauterine insemination cycles

Kabukçu

Çabuş

Öztekin

et al. 2021

J of Obstet and Gynaecol

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Aim: Sonoelastography is an imaging technique that measures tissue strain quantitatively. This study aims to investigate whether the strain rate of endometrium measured by elastography can predict pregnancy after intrauterine insemination (IUI). Methods: This study examined 197 gonadotropin-stimulated IUI cycles of 148 women diagnosed with unexplained infertility from February 2019 to November 2020. Endometrial thickness, pattern, and strain rate were measured by transvaginal ultrasonography immediately before the insemination. The endometrium and the parametrial tissue were selected for regions of interest, and the strain rate was calculated. The measurements were analyzed concerning the IUI outcome. Results: Of the 197 IUI cycles, the pregnancy rate was 15.20% (n = 30), and ongoing pregnancy rate was 12.2% (n = 24). The mean strain rates were not different between pregnant and nonpregnant groups (2.68 AE 1.28 vs. 2.81 AE 1.32, p = 0.651). Strain rate was not predictive for pregnancy, shown by receiver operating characteristic curve analysis; the area under the curve was 0.526 (95% CI 0.413-0.639; p = 0.649). Pregnancy rates were significantly affected by the women's age and the inseminated sperm count. In multiple logistic regression analysis, the other parameters, including body mass index, anti-Müllerian hormone, endometrial thickness, endometrial strain rate, and echogenic endometrial pattern, did not significantly change the odds ratio of pregnancy. Conclusion:The endometrial strain rate does not significantly affect the pregnancy rates in gonadotropin stimulated IUI cycles. It appears that strain rate does not predict IUI outcome. More research is needed to evaluate the usefulness of sonoelastography in infertility treatments.

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“…Overall, most literature has shown that better pregnancy outcomes are observed with increasing EMT, which is in line with our results. For example, a study showed that within gonadotropin treatment IUI cycles, the mean EMT in women achieving the outcome of live birth was greater than those who failed, and 12.2% of live births were observed in cycles with an EMT of more than 13 mm [25]. 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].…”

Section: Discussionmentioning

confidence: 99%

“…Our results indicated that a growing mean number of follicles was connected with increased HMG dose but limited to three. Gonadotropin cycles tend to access more follicles than oral treatment, including clomiphene citrate and letrozole [7,25]. More follicles do have more opportunity to get fertilized, but excess follicles could not contribute to PR and LBR because synchronization among different follicles would damage the endometrial receptivity [15].…”

Section: Discussionmentioning

confidence: 99%

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

Ou¹,

Han²,

Xu³

et al. 2021

Preprint

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Background: This aim of this study was to evaluate the effect of human menopause gonadotropin (HMG) on pregnancy outcomes of infertility patients with intrauterine insemination (IUI) treatments.Methods: This retrospective cohort study analyzed couples using 75 IU HMG as initiate ovarian stimulation method for IUI from January 2015 to December 2019. Couples were divided into four groups according to a total dose of HMG: 189 cycles with a dose <500 IU, 601 with a dose 500 to1000 IU, 199 with a dose 1000 to 1500 IU and 241 with a dose ＞1500 IU. The differences in baseline characteristics and pregnancy outcomes including among the four groups were investigated. We used a logistic regression model to further study the association between various doses of HMG and pregnancy outcomes and adjusted for confounding factors.Results: The study included 792 couples with 1230 cycles, and pregnancy was achieved in 212 (17.2%) cycles, while live birth was achieved in 176 (14.3%) cycles. Stratified analyses revealed that a higher dose of HMG was associated with increased pregnancy rate (PR), live birth rate (LBR), endometrial thickness (EMT) on insemination day, number of follicle ≥18 mm, serum estrogen 2( E2) level, and EMT on the trigger day among four groups, which were all statistically different (P＜0.05). The logistic regression indicated that both PR and LBR were positively associated with the total dose and day of HMG, which were statistically different (P＜0.05).Conclusion: Increasing the total dose and day of HMG may benefit the serum E2 level, EMT, follicle development, and pregnancy outcomes in 75IU HMG stimulated IUI cycles.

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Endometrial thickness after ovarian stimulation with gonadotropin, clomiphene, or letrozole for unexplained infertility, and association with treatment outcomes

Cited by 32 publications

References 37 publications

Letrozole for Female Infertility

Letrozole for Female Infertility

The strain rate of endometrium measured by real‐time sonoelastography as a predictive marker for pregnancy in gonadotropin stimulated intrauterine insemination cycles

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

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