OJOG  Vol.4 No.10 , July 2014
Letrozole versus Gonadotropin in Unexplained Infertile Couples Failed to Conceive with Clomiphene Citrate
Abstract: Background: Unexplained infertility represents about 15% - 20% of infertile couples. Usually, these cases need assistance. Clomiphene citrate is the most used drug for this problem but sometimes pregnancy failed to achieve it, so other options for assistance are gonadotrophin or letrezole. The objective of our study was to compare the pregnancy rate for letrezole and gonadotropin inunexplained infertile women’s who failed to conceive with clomiphene citrate. Methods: This prospective quasi-randomized trial was carried out in cytogenetic unite at obstetrics and gynecology department, Zagazig University Hospital. 140 infertile females were included, induction of ovulation by letrozole for half of them and by gonadotrophin for the other half. Results: There was statistically highly significant decrease in duration of stimulation, E2 levels and endometrial thickness at day of HCG in letrezole group, no significant difference between two groups as regard number of follicles and pregnancy rate per cycle, while the cumulative pregnancy rate and the cost of stimulation are significantly higher in gonadotrophin group. Conclusion: In patient with unexplained infertility who failed to conceive with clomiphene citrate, gonadotrophins have a higher pregnancy rate than letrezole. However, pregnancy rate was high enough with lower cost with letrezole to be acceptable and justified its use in this group of patients.
Cite this paper: Ibrahaiem, M. , Shazly, S. , Helal, K. , Mowafy, H. and El Behery, M. (2014) Letrozole versus Gonadotropin in Unexplained Infertile Couples Failed to Conceive with Clomiphene Citrate. Open Journal of Obstetrics and Gynecology, 4, 636-641. doi: 10.4236/ojog.2014.410088.

[1]   Quaas, A. and Dokras, A. (2008) Diagnosis and Treatment of Unexplained Infertility. Reviews in Obstetrics Gynecology, 1, 69-76.

[2]   Mukherjee, S., Sharma, S. and Chakravarty, B.N. (2010) Comparative in Polycystic Ovarian Syndrome and Unexplained Infertility—A Prospective Clinical Trial. Journal of Human Reproductive Sciences, 3, 80-84.

[3]   Ehert, P., Schertz, C.J. and Ezcurra, D. (2010) Recombinant Human Follicle-Stimulating Hormone Produces More Oocytes with a Lower Total Dose per Cycle in Assisted Reproductive Technologies Compared with Highly Purified Human Menopausal Gonadotrophin: A Meta-Analysis. Reproductive Biology and Endocrinology, 8, 112.

[4]   Menkveld, R. (2010) Clinical Significance of the Low Normal Sperm Morphology Value as Proposed in the Fifth Edition of the WHO Laboratory Manual for the Examination and Processing of Human Semen. Asian Journal of Andrology, 12, 47-58.

[5]   Kamath, M.S. and George, K. (2011) Letrozole or Clomiphene Citrate as First Line for Anovulatory Infertility: A Debate. Reproductive Biology and Endocrinology, 9, 86-88.

[6]   Sarhan, A., Beydoun, H., Jones, H.W. and Bocca, S. (2011) Gonadotrophin Ovulation Induction and Enhancement Outcomes: Analysis of More Than 1400 Cycles. Reproductive BioMedicine Online, 23, 220-226.

[7]   Mitwally, M.F., Biljan, M.M. and Casper, R.F. (2005) Pregnancy Outcome after the Use of an Aromatase Inhibitor for Ovarian Stimulation. American Journal of Obstetrics Gynecology, 192, 381-386.

[8]   Ganesh, A., Goswami, S.K., Chattopadhyay, R., et al. (2009) 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. Journal of Assisted Reproduction and Genetics, 26, 19-24.

[9]   Mukherjee, S., Sharma, S. and Nath Chakravarty, B. (2012) Letrozole in a Low-Cost in Vitro Fertilization Protocol in Intracytoplasmic Sperm Injection Cycles for Male Factor Infertility: A Randomized Controlled Trial. Journal of Human Reproductive Sciences, 5, 170-174.

[10]   Gregoriou, O., Vlahos, N.F. and Konidaris, S. (2008) 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. Fertility and Sterility, 90, 678-683.

[11]   HaqNawaz, F., Virk, S., Qadir, T. and Imam, S. (2013) Comparison of Letrozole and Clomiphene Citrate Efficacy along with Gonadotrophins in Controlled Ovarian Hyperstimulation for Intrauterine Insemination Cycles. Journal of Reproduction and Infertility, 14, 138-142.

[12]   Quintero, R.B., Urban, R., Lathi, R.B. and Westphal, L.M. (2007) A Comparison of Letrozole to Gonadotropins for Ovulation Induction, in Subjects Who Failed to Conceive with Clomiphene Citrate. Fertility and Sterility, 88, 879-885.

[13]   Healey, S., Tan, S.L., Tulandi, T. and Biljan, M.M. (2003) Effects of Letrozole on Superovulation with Gonadotropins in Women Undergoing Intrauterine Insemination. Fertility and Sterility, 80, 1325-1329.

[14]   Baysoy, A., Serdaroglu, H. and Jamal, H. (2006) Letrozole versus Human Menopausal Gonadotrophin in Women Undergoing Intrauterine Insemination. Reproductive BioMedicine Online, 13, 208-212.

[15]   Speroff, L. and Fritz, M.A. (2005) Induction of Ovulation in Clinical Gynecologic Endocrinology and Infertility. 7th Edition, Lippincott, Williams & Wilkins, Philadelphia, 250-255.

[16]   Polyzos, N.P., Tzioras, S. and Badawy, A.M. (2009) Aromatase Inhibitors for Female Infertility: A Systematic Review of the Literature. Reproductive BioMedicine Online, 19, 456-471.