Comparison of pregnancy outcomes in CC resistance PCOS patients undergoing CC plus letrozole and intra uterine insemination treatment with different follicular diameters

AbstractAim: Using Clomiphene citrate (CC) plus letrozole combination to determine the effect of follicular diameter on pregnancy outcomes in CC resistance Polycystic ovary syndrome (PCOS) patients during intra uterine insemination cycles.Material and Methods: The records of infertile patients who presented to the outpatient clinic were retrospectively analysed. PCOS was diagnosed in 536 (23%) patients, 71 (18%) of whom had CC-resistant PCOS using CC plus letrozole. The patients were divided into two groups; follicular diameter 17-19 mm (group 1, n = 31) and 20-22 mm (group 2, n = 40).Results: The pregnancy rate in group 1 was 20% (6/30), the abortion rate was 17% (1/6), and the multiple pregnancy rate was 17% (1/6). In group 2, the pregnancy rate was 17% (7/41), the abortion rate was 14% (1/7) and the multiple pregnancy rate was 14% (1/7). There was no statistically significant between-group difference in the pregnancy (p =0.3), abortion (p = 0.8) or multiple pregnancy rates (p =0.8).Conclusion: In PCOS patients with CC plus letrozole and intra uterine insemination ovulation induction, pregnancy rate is not related to follicular size between 17-22 mm on hCG day. Although there was no direct relationship between follicular size and endometrial thickness, it was found that delaying HCG was not significant for better results.

PDF

___

1. Tarlatzis BC, Fauser BCJM, Legro RS, et al. Consensus on infertility treatment related to polycystic ovary syndrome. In: Human Reproduction 2008;23:462-77.
2. Nakamura Y, Sugino N, Mioko O, et al. Effects of clomiphene citrate on the endometrial thickness and echogenic pattern of the endometrium. Fertil Steril 1997;67:256-60.
3. Holzer H, Casper R, Tulandi T. A new era in ovulation induction. Fertil Steril 2006;85:277-84.
4. Mitwally MFM, Casper RF. Use of an aromatase inhibitor for induction of ovulation in patients with an inadequate response to clomiphene citrate. Fertil Steril 2001;75:305-9.
5. Stanger JD, Yovich JL. Failure of human oocytes release at ovulation. Fertil Steril 1984;41:827-32.
6. Cohlen BJ. Should we continue performing intrauterine inseminations in the year 2004? Gynecol Obstet Invest 2005;59:3-13.
7. Shalom-Paz E, Marzal A, Wiser A, et al. Does optimal follicular size in IUI cycles vary between clomiphene citrate and gonadotrophins treatments? Gynecol Endocrinol 2014;30:107-10.
8. Farhi J, Orvieto R, Gavish O, et al. The association between follicular size on human chorionic gonadotropin day and pregnancy rate in clomiphene citrate treated polycystic ovary syndrome patients. Gynecol Endocrinol 2010;26:546-8.
9. Fauser BCJM. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril 2004;81:19-25.
10. Homburg R. Clomiphene citrate-end of an era? A minireview. Hum Reprod 2005;20:2043-51.
11. Nilsson L, Wikland M, Hamberger L, et al. Simplification of the method of in vitro fertilization: Sonographic measurements of follicular diameter as the sole index of follicular maturity. J In Vitro Fert Embryo Transf 1985;2:17-22.
12. Haritha S, Rajagopalan G. Follicular growth, endometrial thickness, and serum estradiol levels in spontaneous and clomiphene citrate-induced cycles. Int J Gynaecol Obstet 2003;81:287-92.
13. Messınıs IE, Templeton A. Urinary oestrogen levels and follicle ultrasound measurements in clomiphene induced cycles with an endogenous luteinizing hormone surge. BJOG: An International J Obstetrics & Gynaecology 1986;93:43-9.
14. Ibérico G, Vioque J, Ariza N, et al. Analysis of factors influencing pregnancy rates in homologous intrauterine insemination. Fertil Steril 2004;81:1308- 13.
15. Palatnik A, Strawn E, Szabo A, et al. What is the optimal follicular size before triggering ovulation in intrauterine insemination cycles with clomiphene citrate or letrozole? An analysis of 988 cycles. Fertil Steril 2012;97:1089-94.
16. Buzaglo K, Velez M, Shaulov T, et al. Leading follicle size in modified natural cycle IVF- predictor of successful outcome? Fertil Steril 2012;98;267-75.
17. Seckin B, Pekcan MK, Bostanci EI, t al.Comparison of pregnancy rates in PCOS patients undergoing clomiphene citrate and IUI treatment with different leading follicular sizes. Arch Gynecol Obstet 2016; 293:901-6