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KMID : 1189220090360020111
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Korean Journal of Reproductive Medicine
2009 Volume.36 No. 2 p.111 ~ p.119
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Clinical Efficacy of Clomiphene Citrate and Letrozole Combined with Gonadotropins for Superovulation in Patients with Clomiphene-Induced Thin Endometrium
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Lee Eun-Joo
Park Ki-Hyun
Lee Byung-Seok
Cho Si-Hyun
Kim Hye-Yeon
Yang Hyo-In
Park Hyeon-Jong
Choi Young-Sik
Cho Dong-Jae
Seo Seok-Kyo
Lee Kyoung-Eun
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Abstract
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Objective: The aim of this study was to compare the clinical efficacy of clomiphene citrate (CC) and letrozole combined with gonadotropins for controlled ovarian stimulation (COS) in patients with CC-induced thin endometrium.
Methods: Fifty-one intrauterine insemination cycles perfomed in patients who previously had a thin endometrium (<8mm) to ovulation induction using CC were included in this study. A CC 100mg/day (CC+gonadotropin group, n=26) or letrozole 2.5 or 5 mg/day (letrozole+gonadotropin group, n=25) was administered on day 3-7 of the menstrual cycle, combined with gonadotropins at dose 75-150IU every other day starting on day 5-7. We compared total dose of gonadotropin used, endometrial thickness, endometrial pattern, number of follicles ≥14mm on hCG day, pregnancy rate and multiple pregnancy rate between the two groups.
Results: There were no significant differences in clinical characteristics between the two groups. In both groups, the endometrium was significantly thicker than that of previous ovulation induction cycles using CC. No significant differences were found in the total dose of gonadotropin used, day of hCG administration, the rate of triple endometrium and pregnancy rate. The number of follicles ≥ 14mm was significantly lower (3.7±1.7 vs. 2.8±1.7, P=0.03) and the endometrium on hCG day was significantly thicker (7.7±1.5 vs. 9.1±1.7, P=0.001) in letrozole+gonadotropin group compared to CC+gonadotropin group.
Conclusion: The clomiphene citrate and letrozole combined with gonadotropins appear to avoid the undesirable effects on the endometrium frequently seen with CC for ovulation induction. However, in terms of adequate endometrial development or optimal follicular growth, letrozole may be more beneficial than CC for gonadotropin-combined COS in patients with CC-induced thin endometrium. Further prospective randomized controlled studies in a larger scale will be necessary to confirm our findings.
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KEYWORD
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Endometrium, Clomiphene citrate, Aromatase inhibitor letrozole, Controlled ovarian stimulation (COS), Intrauterine insemination (IUI)
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