Randomized controlled trial comparing superovulation with letrozole versus recombinant follicle-stimulating hormone combined with intrauterine insemination for couples with unexplained infertility who had failed clomiphene citrate stimulation and intrauterine insemination

Gregoriou, O.; Vlahos, Nikolaos; Konidaris, S.; Papadias, K; Botsis, D.; Creatsas, George

doi:10.1016/j.fertnstert.2007.06.099

Cited by 51 publications

(39 citation statements)

References 42 publications

(35 reference statements)

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“…There are, however, significantly higher pregnancy rates reported with gonadotropin (hMG/FSH) stimulation than IUI cycles stimulated with letrozole [6,28]. Nevertheless, it is suggested that ovulation induction with letrozole is associated with a satisfactory pregnancy rate as it is more cost-effective, simple and convenient to patients when compared to gonadotropins [5,13].…”

Section: Discussionmentioning

confidence: 99%

“…Letrozole, a highly selective AI, has been found to be effective in inducing ovulation in anovulatory and ovulatory infertile women with inadequate response to CC [14,15]. Though higher clinical pregnancy rates were observed with gonadotropins than with letrozole stimulation in CC-resistant women undergoing IUI [5,6], both groups have confirmed that letrozole is associated with acceptable pregnancy rates, cost-effectiveness, decreased side-effects and patient convenience, as compared to gonadotropins.…”

Section: Introductionmentioning

confidence: 90%

“…In such cases, the traditional option is to administer gonadotropins, though it is associated with an enhanced risk of multiple pregnancies and ovarian hyperstimulation [3]. Several research groups have observed a higher pregnancy rate with gonadotropin therapy as compared to oral ovulation inducing agents in women failing to conceive with CC/IUI [4][5][6]. Recently, a consensus has been reached on the use of either exogenous gonadotropins or laparoscopic ovarian surgery in CC-resistant women as a second-line of intervention [7].…”

Section: Introductionmentioning

confidence: 99%

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Comparison of letrozole with continuous gonadotropins and clomiphene-gonadotropin combination for ovulation induction in 1387 PCOS women after clomiphene citrate failure: a randomized prospective clinical trial

Ganesh

Goswami

Chattopadhyay

et al. 2009

J Assist Reprod Genet

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Purpose Letrozole, though reported to be an effective ovulation inducing agent, warrants larger randomized trials. The purpose of this study is to compare the efficacy of letrozole with that of rFSH and clomiphene citrate(CC)/rFSH for ovarian stimulation in IUI cycles. Methods Randomized, prospective, single-blinded clinical trial. 1387 PCOS women after CC failure were randomized into three groups: Group A received letrozole, Group B received CC with two doses rFSH and Group C received continuous rFSH day 2 onwards until hCG injection. Results Group A, B and C had an ovulation rate of 79.30%, 56.95% and 89.89% and cycle cancellation rate of 20.70%, 43.05% and 10.11%, respectively. Pregnancy rates in Group A, B and C were 23.39%, 14.35% and 17.92%, while the miscarriage rates were 13.80%, 16.67% and 14.52%, respectively. Conclusion Letrozole appears to be a suitable ovulation inducing agent in PCOS women with CC failure and is found to be most effective when baseline estradiol level >60 pg/ml.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 90%

Section: Introductionmentioning

confidence: 99%

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Comparison of letrozole with continuous gonadotropins and clomiphene-gonadotropin combination for ovulation induction in 1387 PCOS women after clomiphene citrate failure: a randomized prospective clinical trial

Ganesh

Goswami

Chattopadhyay

et al. 2009

J Assist Reprod Genet

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“…Ovarian stimulation induces endometrial alterations that may affect implantation rates compared with natural cycles [Horcajadas et al 2007]. Several reports have shown that stimulation with letrozole results in acceptable pregnancy rates, cost-effectiveness, decreased side-effects, and patient convenience, as compared to gonadotropins in CC-resistant women undergoing IUI [Gregoriou et al 2008;Quintero et al 2007]. Though various advantages associated with the use of letrozole as an ovulation inducing drug are documented, there is a lack of information on the effect of letrozole on endometrial receptivity.…”

Section: Discussionmentioning

confidence: 99%

Endometrial receptivity markers in infertile women stimulated with letrozole compared with clomiphene citrate and natural cycles

Ganesh

Chauhan²,

Chakravarty

et al. 2013

Systems Biology in Reproductive Medicine

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Though various advantages associated with the use of letrozole as an ovulation inducing drug are documented, there is inadequate information regarding its effect on endometrial receptivity. Expression of endometrial receptivity markers including a v b 3 integrin, L-selectin, LIF, and pinopods during the implantation window in infertile women stimulated with letrozole or clomiphene citrate (CC), and spontaneous cycles is investigated. A total of 36 women were included in the study out of which 16 women were diagnosed with primary unexplained infertility and the other 20 women with severe oligoasthenozoospermic/azoospermic male partners. Both groups were sub-divided into three groups; women stimulated with letrozole, or with CC, and the third group was allowed to ovulate spontaneously (natural cycles). Women having natural cycles and not given any drug were considered as controls. Once ovulation was confirmed by ultrasonography, endometrial samples were collected on the seventh day post-ovulation and analyzed. In women with unexplained infertility treated with letrozole and CC, epithelial and stromal expression of a v b 3 integrin, L-selectin, leukemia inhibitory factor (LIF), and pinopod formation was found to be significantly higher as compared to controls. Expression of these receptivity markers was found to be comparable amongst the letrozole, CC, and control groups in women with severe oligoasthenozoospermic/azoospermic male partners. Cell cycle analysis showed similar cell cycle phase fractions on comparing the CC and the letrozole groups. Stimulation with letrozole and CC appears to enhance endometrial receptivity in women with unexplained infertility. However, letrozole and CC did not have any significant effect on the endometrial receptivity markers of women with severe oligoasthenozoospermic/azoospermic male partners.

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“…In one randomized trial, letrozole 5mg daily for 5 days was compared to 150 IU daily of gonadotropins, beginning at day 3 of the cycle, with later adjustment based on monitoring [31] A second randomized controlled trial compared letrozole at 5mg on days 3-7 of cycle with human menopausal gonadotropins at 75-150 IU beginning on day 3 of the cycle. Pregnancy rates were again not statistically different at 18.4% for letrozole versus 15.7% for gonadotropins, with the cost being much higher for the injectable group.…”

Section: Unexplained Infertilitymentioning

confidence: 99%

Glimpse on Splendid Aromatase Inhibitor – Letrozole - A Pragmatic Review

Neerjesh¹

2017

WJPR

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Letrozole is the third-generation aromatase inhibitor (AI) most commonly used in assisted reproduction. It brings ovulation by inhibiting estrogen production; the consequent hypoestrogenic state enhances GnRH release and pituitary follicle-stimulating hormone (FSH) synthesis. Letrozole has fewer side effects, and a shorter halflife than clomiphene citrate, and no demonstrable effect upon the receptivity of the endometrium. It is effective in treating women with chronic anovulation, unexplained infertility and diminished ovarian reserve. Its safety is superior to clomiphene citrate. Utilizing bioequivalent doses, letrozole pregnancy rates are equal or superior to clomiphene citrate. Several studies reveal situations where it is more efficacious than gonadotropin treatment. A conclusion established was letrozole is as effective as other methods of ovulation induction. Further randomizedcontrolled studies are warranted to define more clearly the efficacy and safety of letrozole in human reproduction.

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Randomized controlled trial comparing superovulation with letrozole versus recombinant follicle-stimulating hormone combined with intrauterine insemination for couples with unexplained infertility who had failed clomiphene citrate stimulation and intrauterine insemination

Cited by 51 publications

References 42 publications

Comparison of letrozole with continuous gonadotropins and clomiphene-gonadotropin combination for ovulation induction in 1387 PCOS women after clomiphene citrate failure: a randomized prospective clinical trial

Comparison of letrozole with continuous gonadotropins and clomiphene-gonadotropin combination for ovulation induction in 1387 PCOS women after clomiphene citrate failure: a randomized prospective clinical trial

Endometrial receptivity markers in infertile women stimulated with letrozole compared with clomiphene citrate and natural cycles

Glimpse on Splendid Aromatase Inhibitor – Letrozole - A Pragmatic Review

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