Letrozole For Induction Research Articles

Comparison of Clomiphene Citrate and Letrozole in induction of ovulation among patients with PolyCystic Ovarian syndrome (PCOS) Primary Sub-fertility

Objective: To compare the efficacy of clomiphene and Letrozole in the induction of ovulation in patients with primary ovarian sub-fertility. Methodology: This was a Randomized control trial study carried out at Dow University Hospital Karachi, Ojha Campus, Karachi after approval of synopsis from February 2016 to January 2017. The required sample size was 164 (82 in the Letrozole group and 82 in the CC group). Non-probability consecutive sampling technique was used. Females of 18-40 years irrespective of weight, years of marriage, and duration of sub-fertility with primary ovarian sub-fertility were included in the study. SPSS was used for data analysis. Results: Total of 164 women were enrolled in the study. 82 women were given Clomiphene Citrate and 82 were treated with Letrozole. The mean age was found to be 28.48±4.12 in the clomiphene citrate group whereas 28.45±3.01 in the Letrozole group. The results showed improved results among the group with Letrozole drug compared to Clomiphene Citrate. Efficacy was positively found with 1st cycle, 2nd cycle & 3rd cycle in 2 (2.4%), 23 (28.05%) & 32 (39.02%) respondents respectively with Clomiphene Citrate. Whereas efficacy was positive with 1st cycle, 2nd cycle & 3rd cycle in 18 (21.9%), 34 (41.4%) & 24 (29.2%) respondents respectively with Letrozole. Conclusion: Letrozole appeared to be the effective drug of choice in ovulation induction among patients who failed to conceive, however, the clomiphene citrate was found to be most effective in women. The dosage of Letrozole is much lower mg with effective pregnancy results compared to Clomiphene Citrate clomiphene citrate.

Comparative study of the efficacy of combined metformin–clomiphene citrate versus combined metformin–letrozole in induction of ovulation in overweight women with polycystic ovarian syndrome

Background Polycystic ovary syndrome (PCOS) is the common cause of infertility. Clomiphene citrate (CC) is the first-line treatment in ovulation induction. Metformin biguanide has been used in insulin resistance in PCOS women. Adding metformin to CC in the CC-resistant PCOS was highly effective in achieving ovulation in 68.6–77.7% of patients. Letrozole, aromatase inhibitor, its use in patients with CC-resistant PCOS achieved ovulation 54.6–84.4% of the time. Aim We aimed to compare the efficacy of combined metformin–CC to combined metformin–letrozole in ovulation induction in overweight infertile PCOS women. Patients and methods A prospective randomized study was conducted at Obstetrics & Gynecology Department in Tanta University Hospitals. In total, 40 infertile overweight cases with PCO were included. Cases were randomly allocated in two groups. Results The mean age was 26.40 ± 5.20 years for CC group and 26.50 ± 5.10 years for letrozole group. BMI was 27.50 ± 1.43 for CC group and 27.45 ± 1.36 for letrozole group. The duration of infertility was 2.90 ± 1.40 years for CC group and 2.88 ± 1.21 for letrozole group. There was insignificant difference in both groups as regards the follicles more than 18 mm and endometrial thickness. But, as regards progesterone level, there was a statistically significant increase in letrozole group than CC group (P<0.005). Concerning pregnancy rate, there was insignificant difference between two groups. Conclusion The present investigation demonstrated that both CC and letrozole are similarly viable in treatment of infertility in PCOS patients, when joined with metformin treatment.

Randomized interventional clinical trial to estimate the efficacy of clomiphene citrate versus letrozole in induction of ovulation in infertility

Randomized interventional clinical trial to estimate the efficacy of clomiphene citrate versus letrozole in induction of ovulation in infertility

Clomiphene Citrate versus Letrozole for Induction of Ovulation in Infertile women having Polycystic Ovarian Syndrome (Randomized Controlled Trial)

Background: Polycystic ovary syndrome is a disorder but with unclear etiology that its diagnosis depends on exclusion of other etiologies with ovulatory disorders and androgen excess as congenital adrenal hyperplasia, 21-hydroxylase deficient non classic congenital adrenal hyperplasia (NCAH), adrenal or ovarian androgen-secreting tumors, disorders of adrenocortical dysfunction as Cushing’s disease, and abuse of androgenic or anabolic drugs. Polycystic ovary syndrome affects approximately 6-15% of women in reproductive age and constitutes 50% of the causes of infertility in women. Aim of the Work: To compare the efficacy of letrozole on ovulation induction to that of clomiphene citrate in women suffering polycystic ovary syndrome and the effect on the follicular maturation, endometrial thickness and pregnancy rate. This study was carried in the outpatient infertility clinic of Ain-Shams Maternity Hospital during the period from November 2020 till April 2021. Patients and Methods: This study included 80 infertile women diagnosed as having polycystic ovary syndrome. Women were randomized into two groups. Letrozole group (1) included 40 women who were given the aromatase inhibitor (Letrozole) orally in a 5mg dose daily from day 3 to day 7 of the menstrual cycle. While Clomiphene citrate group (2) included 40 women who were given the clomiphene citrate orally in 100mg dose daily from day 3 to day 7 of the menstrual cycle. All women were counseled and informed consent was obtained before recruitment. Results: In this study, ovulation rate was significantly more frequent in the Letrozole group (82.5%, 33 women reached ovulation successfully) than in Clomiphene citrate group (60%, 24 women reached ovulation successfully) within P value=0.024. Clomiphene citrate at a dose of 100mg showed more efficacies in the number of follicle ≥18mm than Letrozole at a dose of 5mg. In Letrozole group, the number of follicles (≥18mm in diameter) ranged from 1 to 2 with a Mean±SD= 1.4±0.65 and in Clomiphene citrate group, the number of follicles (≥18mm in diameter) ranged from 1 to 3 with a Mean±SD= 1.9± 0.41 (P value=0.0001). Conclusion: Letrozole can be considered as a first line treatment of anovulation in polycystic ovary syndrome. But, moreover studies including larger number of cases will further confirm the efficacy of letrozole versus clomiphene citrate in induction of ovulation, reaching to the optimum doses for aromatases inhibitors, more observation on endometrial thickness, incidence of pregnancy outcomes, incidence of abortion and incidence of congenital fetal malformations.

A Comparison Between the Effect of Vaginal Sildenafil Versus Oral Estradiol Valerate on Ultrasound Parameters of Endometrial Receptivity and Follicular Growth in Iraqi Females Receiving Letrozole for Induction of Ovulation

Endometrial thickness (ET) is one of the best predictors of implantation rate and pregnancy success rate because endometrial growth depends on hormones. Estrogen regulates the proliferative phase, endometrial proliferation induced by estrogen after menstruation is largely dependent on blood flow to the basal endometrium that produces progesterone receptors which are required for progesterone-regulated endometrial growth in the secretory process. To compare the effect of estradiol valerate vs. sildenafil citrate on endometrial receptivity and subsequent pregnancy outcome in unexplained infertility patients receiving letrozole for ovulation induction. Herein, 21 patients with unexplained infertility underwent ovulation induction by letrozole (2.5 mg). Patients were divided into 2 groups; group A (10 patients) were given sildenafil tablets vaginally (25 mg) four times daily and group B (11 patients) were treated with estradiol valerate tablet 2 mg/12 hours. Patients were evaluated by transvaginal ultrasonography (TVS) to determine endometrial thickness, pattern, size, and the number of the dominant follicles, serum assessment of Vascular Endothelial Growth Factor (VEGF) level at trigger day, and chemical pregnancy outcome 14 days later. Results showed that the endometrial thickness, patterns of the endometrium, VEGF, size of the dominant follicle at the trigger day, and pregnancy rates were not significantly different between the two groups. However, the difference in the number of the dominant follicles at trigger day was statistically significant which is more in the sildenafil treated group. The present study confirmed the findings of both Sildenafil and E2 valerate to boost endometrial receptivity and pregnancy rate.

Aromatase Inhibitor Versus Clomiphene Citrate for Induction of Ovulation in Unexplained Infertility

Background: Infertility is the inability of a sexually active couple with no contraception to achieve natural pregnancy within one year. Unexplained female infertility should be a term used when the female reproductive system has been evaluated according to current agreed standards, and no abnormalities are detected. Clomiphene citrate (CC) has been used as a first-line ovulation induction agent. Aromatase inhibitors are new groups of drugs for fertility treatment. Letrozole is an orally-active aromatase inhibitor, with good potential for ovulation induction. Objective: This study compared the effect of clomiphene citrate and letrozole in induction of ovulation in the treatment of infertility. Patients and methods: This prospective randomized controlled study was conducted at Obstetrics and Gynecology Department, Al-AzharUniversityHospitals and Al-AhrarHospital (ministry of health) on 100 women between 20 - 35 years old having unexplained infertility. Patients were divided into two equal groups: Letrozole group received 5 mg of letrozole orally daily from day 3 to day 7 of menses, and CC group, women received 100 mg of clomiphene citrate orally once daily from day 3 to day 7 of the menses and for up to three menstrual cycles. Results: There was a significant increase of positive pregnancy test in letrozole group compared to clomiphene group.There was a significant difference in multiple pregnancy rate and high significant differences in Doppler flow indices between letrozole group and clomiphene group. Conclusion:Letrozole has a better ovulation rate with better follicular development and higher pregnancy rate, CC group has less effect on the endometrial thickness and side effects.

Effect of estradiol valerate on the pregnancy rate in patients receiving letrozole for induction of ovulation

Abstract Background Letrozole is as effective as clomiphene citrate for induction of ovulation in patients with PCOS. Adequate endometrial development is required for pregnancy to occur, and pregnancy rates were found to be higher when the endometrium reached at least 10 mm thickness. Objective To study the effect of estradiol valerate on the endometrial thickness and subsequently the pregnancy rate in PCOS cases receiving letrozole for induction of ovulation as compared to letrozole alone. Study design A randomized controlled study. Setting was at the infertility clinic of the Cytogenetic and Endoscopy Unit, Zagazig University Hospital. Material and methods The study included 273 patients who underwent ovulation induction and timed intercourse. Patients were divided into 2 groups: controlled ovarian stimulation was done in group 1 by letrozole with addition of estradiol valerate and in group 2 by letrozole alone. Results As regard the clinical pregnancy rate, we found a statistically significant difference between the 2 studied groups, with documented clinical pregnancy in 34 patients in group 1 compared to only 16 patients in group 2. Conclusion This study showed that the pregnancy rate achieved with letrozole/estradiol valerate combination was significantly higher than with letrozole alone. This was attributed to the improvement of endometrial thickness by estradiol valerate.

A new look at tamoxifen: co-administration with letrozole in intrauterine insemination cycles

To assess the effectiveness of tamoxifen administration with letrozole in the context of intrauterine insemination (IUI) cycles. This prospective double-blinded study included 130 patients. After randomization, 65 patients in group A received letrozole + tamoxifen and human menopausal gonadotropin (HMG), whereas 65 patients in group B received placebo instead of tamoxifen. In both groups, the parameters recorded were total number of follicles with ≥16 and 18 mm diameter, endometrial thickness and appearance, and total HMG administered. The results were compared between groups after single-stage IUI was performed. Total dominant follicles in both groups were similar (mean number of follicles with diameter ≥16 and 18 mm was 1.5 ± 1.4 and 1.6 ± 1.1, respectively, in group A and 1.5 ± 1.1 and 1.6 ± 1, respectively, in group B; at the same time with less HMG usage in group A (255 ± 167 vs. 313 ± 174 IU), and higher pregnancy rate in group A (18.7 vs. 11.7 %); but none of them was statistically significant). Surprisingly, endometrial thickness was significantly higher in group A (7.7 ± 1.5 vs. 7 ± 1.3 mm; P value 0.008). In addition to the efficacy of tamoxifen in co-administration with clomiphene citrate, it has promising effects with letrozole in induction of ovulation cycles with or without IUI.

Letrozole induction of ovulation in women with clomiphene citrate–resistant polycystic ovary syndrome may not depend on the period of infertility, the body mass index, or the luteinizing hormone/follicle-stimulating hormone ratio

Letrozole induction of ovulation in clomiphene citrate-resistant women with polycystic ovary syndrome is associated with an ovulation rate of 54.6% and pregnancy rate of 25%. There was no significant difference between letrozole responders and nonresponders in age, period of infertility, body mass index, waist circumference, LH, FSH, or LH/FSH ratio.