Comparison of ovulation induction treatments in intrauterine insemination; A retrospective study in a tertiary center

Aim: In this study, were compared of different ovarian stimulation drugs used in intrauterine insemination ( IUI) cycles.Material and Methods: The records of 3420 infertile patients who presented to the outpatient clinic were retrospectively analyzed. The patients were evaluated into three groups ( n=421). 170 patients who received letrozole treatment were included in group 1, 50 patients who received Clomiphene citrate (CC) treatment were included in group 2, and 201 patients who received gonadotropins treatment were included in group 3.Results: The mean numbers of follicles were in IUI cycles stimulated with the use of letrozole (1.5± 0.6), CC (1.6 ± 0.6), and gonadotropins (1.6 ± 0.7). After stimulation with letrozole, CC and gonadotropins, pregnancy rates were 13(7.6%), 6(12%) and19(9.4%); Abortion rates were 2(1.1%), 1(2%) and 3(1.4%). Multiple pregnancy occurred in, 1/170 (0.58%), 1/50 (2%) and 2/201 (0.99%) in the letrozole, CC and gonadotropins groups.Conclusion: After stimulation with treatment protocols; pregnancy rates, abortion rates, and multiple pregnancy rates were similar. The question that this study set out to answer was of effectiveness. Different ovarian stimulation protocols used in IUI programs, clinical opportunities, experience of the person, does affect the results of the study

PDF

___

1. ESHRE. The ESHRE Capri Workshop Group. Intrauterine insemination. Human Reproduction Update 2009;15:265-77
2. van Rumste MM, Custers IM, van der Veen F, et al. The influence of the number of follicles on pregnancy rates in intrauterine insemination with ovarian stimulation: A meta-analysis. Hum Reprod Update. 2008;14:563- 70.
3. Dehbashi S,Parsanezhad ME, Alborzi S, et al. Effect of clomiphene citrate on endometrium thickness and echogenic patterns. Int J Gynecol Obstet 2003;80:49- 53.
4. Holzer H, Casper R, Tulandi T. A new era in ovulation induction. Fertil Steril 2006;85:277-84.
5. Delbaere A, Smits G, Olatunbosun O, et al. New insights into the pathophysiology of ovarian hyperstimulation syndrome. What makes the difference between spontaneous and iatrogenic syndrome? HHum Reprod. 2004;19:486-9
6. who laboratory manual for the examination of human semen and sperm-cervical mucus interaction. Int J Androl 1996;19:149-9
7. Diamond MP, Legro RS, Coutifaris C, et al. Letrozole, gonadotropin, or clomiphene for unexplained infertility. N Engl J Med 2015;24;373:1230-40
8. Mitwally MF, Casper RF.Aromatase inhibition reduces gonadotrophin dose required for controlled ovarian stimulation in women with unexplained infertility. Hum Reprod 2003;18:1588-97
9. Al-Fozan H, Al-Khadouri M, Tan SL, et al. A randomized trial of letrozole versus clomiphene citrate in women undergoing superovulation. Fertil Steril 2004;82:1561- 3
10. Gregoriou O, Vlahos NF, Konidaris S, et al. 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. Fertil Steril 2008;90:678-83.
11. Huang S, Wang R, Li R, et al. Ovarian stimulation in infertile women treated with the use of intrauterine insemination: a cohort study from China. Fertil Steril 2018;109:872-8.
12. Fouda UM, Sayed AM. Extended letrozole regimen versus clomiphene citrate for superovulation in patients with unexplained infertility undergoing intrauterine insemination: A randomized controlled trial. Reprod Biol Endocrinol 2011;21;9:84
13. Khanna SC1, Kumar A, Joy SG, et al. Is letrozole superior to clomiphene for ovarian stimulation prior to intrauterine insemination? Arch Gynecol Obstet 2013;287:571-5
14. Baysoy A, Serdaroglu H, Jamal H, et al. Letrozole versus human menopausal gonadotrophin in women undergoing intrauterine insemination. Reprod Biomed Online 2006;13:208-12 .
15. Guzick DS, Carson SA, Coutifaris C et al. Efficacy of superovulation and intrauterine insemination in the treatment of infertility. NN Engl J Med 1999;8;341:128- 9.
16. Hansen KR, He AL, Styer AK, et al. Predictors of pregnancy and live-birth in couples with unexplained infertility after ovarian stimulation-intrauterine insemination. Fertil Steril 2016;105:1575-83