Letrozole versus clomiphene in prevention of premature LH surge in women undergoing intrauterine insemination

Abstract

Introduction Soft stimulation protocols were developed to impart a less stressful and less expensive mode of stimulation for patient insemination. Aim To evaluate the effect of letrozole versus clomiphene citrate (CC) in prevention of premature luteinizing hormone (LH) surge. Patients and methods This is a prospective comparative study held at Obstetrics and Gynecology Department, Alzahraa University Hospital. A total of 90 infertile patients between 18 and 35 years of age with unexplained infertility or mild male factor were included. Overall, 30 patients had induction by human menopausal gonadotropin and then CC from seventh day of the cycle; 30 patients had induction by human menopausal gonadotropin and then letrozole from seventh day of the cycle, and 30 patients had induction by human menopausal gonadotropin only and were evaluated according to LH and estradiol (E2) on triggering day, folliculometry, and pregnancy outcome. Results We found that the letrozole was associated with lesser LH on triggering day and higher endometrial thickness than the other two groups, and CC was associated with higher E2 on triggering day and number of mature follicles than the other two groups. The difference between the study groups in LH, E2, number of mature follicles, and endometrial thickness was statistically significant, whereas the differences in pregnancy rate was statistically insignificant. Conclusion The study shows that clomiphene and letrozole are available options to prevent LH surge.