Ovulation Induction In Women Research Articles

Competence of Combined Low Dose of Human Chorionic Gonadotropin (HCG) and Clomiphene Citrate (CC) Versus Continued CC during Ovulation Induction in Women with CC-Resistant Polycystic Ovarian Syndrome: A Randomized Controlled Trial.

Background and Objectives: Polycystic ovarian syndrome (PCOS) is a widespread endocrine disorder affecting 5-18% of females in their childbearing age. The aim of this study is to assess the efficacy of combining a low dosage of human chorionic gonadotropin (HCG) along with clomiphene citrate (CC) for stimulating ovulation in infertile women diagnosed with CC-resistant PCOS. Materials and Methods: A randomized controlled trial was carried out on 300 infertile CC-resistant PCOS women. All participants were assigned to two groups: the CC-HCG group and the CC-Placebo group. Subjects in the CC-HCG group were given CC (150 mg/day for 5 days starting on the 2nd day of the cycle) and HCG (200 IU/day SC starting on the 7th day of the cycle). Subjects in the CC-Placebo group were given CC and a placebo. The number of ovarian follicles > 18 mm, cycle cancellation rate, endometrial thickness, ovulation rate, clinical pregnancy rate, and occurrence of early ovarian hyper-stimulation syndrome were all outcome variables in the primary research. Results: Data from 138 individuals in the CC-HCG group and 131 participants in the CC-Placebo group were subjected to final analysis. In comparison to the CC-Placebo group, the cycle cancellation rate in the CC-HCG group was considerably lower. The CC-HCG group exhibited a substantial increase in ovarian follicles reaching > 18 mm, endometrial thickness, and ovulation rate. The clinical pregnancy rate was higher in the CC-HCG group (7.2% vs. 2.3%; CC-HCG vs. CC-Placebo). Upon adjusting for BMI and age, the findings of our study revealed that individuals in the CC-HCG group who had serum prolactin levels below 20 (ng/mL), secondary infertility, infertility duration less than 4 years, baseline LH/FSH ratios below 1.5, and serum AMH levels more than 4 (ng/mL) had a higher likelihood of achieving pregnancy. In the CC-Placebo group, there was a greater prediction of clinical pregnancy for those with serum AMH (<4), primary infertility, serum prolactin ≤ 20 (ng/mL), baseline LH/FSH < 1.5, and infertility duration < 4 years. Conclusions: The use of a small dose of HCG along with CC appeared to be an effective treatment in reducing cycle cancelation, improving the clinical pregnancy rate and ovulation rate in CC-resistant PCOS patients. The trial was registered with Clinical Trials.gov, identifier NCT02436226.

Myo-inositol Effects on Induction of Ovulation in Women with Polycystic Ovary Syndrome

Myo-inositol Effects on Induction of Ovulation in Women with Polycystic Ovary Syndrome

Strong Early Impact of Letrozole on Ovulation Induction Outperforms Clomiphene Citrate in Polycystic Ovary Syndrome.

Polycystic ovary syndrome is a common endocrine disorder, characterized by hyperandrogenism and/or chronic oligo/anovulation, which leads to infertility. The aim of this systematic review and meta-analysis was to explore the efficacy of letrozole compared with clomiphene citrate for ovulation induction in women with polycystic ovarian syndrome. The study protocol has been registered with PROSPERO (registration number CRD42022376611). The literature search included randomized clinical trials. We conducted our systematic literature search across three medical databases: MEDLINE (via PubMed), Cochrane Library (CENTRAL), and Embase. The data synthesis employed a random effects model. Out of the 1994 articles screened, 25 studies fulfilled the inclusion criteria. The letrozole group exhibited a significant increase in endometrial thickness (mean difference = 1.70, confidence interval: 0.55-2.86; I2 = 97%, p-value = 0.008). The odds of ovulation (odds ratio = 1.8, confidence interval: 1.21-2.69; I2 = 51%, p-value = 0.010) and pregnancy (odds ratio = 1.96, confidence interval: 1.37-2.81; I2 = 32%, p-value = 0.002) were significantly higher. The resistance index of the subendometrial arteries showed a significant decrease (mean difference = -0.15, confidence interval: -0.27 to -0.04; I2 = 92%, p-value = 0.030). Women diagnosed with polycystic ovarian syndrome and treated with letrozole for ovulation induction had increased ovulation and pregnancy rates and increased endometrial thickness. The lower resistance index of subendometrial arteries can enhance intrauterine circulation, creating more favorable conditions for embryo implantation and development.

P-622 Prospectively randomized study of intraovarian injections of autologous platelet-rich plasma (PRP) into one alternating ovary in Primary Ovarian Insufficiency (POI)

Abstract Study question Does intraovarian injection of autologous PRP affect ovarian function in women with POI? Summary answer Ovaries that were injected with PRP demonstrated a significant increase in follicles &amp;gt;4mm in size compared to the untreated contralateral ovaries. What is known already The injection of PRP into ovaries has been reported to improve subsequent ovarian response to ovulation induction in women with POI and is now widely used in fertility centers in women with POI as well as in women with premature ovarian aging (POA). Prospectively randomized studies are, however, lacking. Study design, size, duration This is a Randomized Controlled Trial with recruitment from July 2018 - November 2023. 40 patients were screened; 34 qualified. POI was defined by amenorrhea among women &amp;lt; 40 years old, with FSH &amp;gt; 30 mIU/mL, undetectable AMH, and no follicles &amp;gt;4mm. For each participant one ovary was randomly selected for treatment ( with the Sealed Envelope Ltd 2022 tool). The study was powered to detect a 20% response in the treated versus untreated ovary. Participants/materials, setting, methods For each patient (n = 34), 10mL of blood was drawn into ReganLab vacutainer and centrifuged. Platelets were re-suspended in 1.5mL of plasma. PRP was injected into the stroma of one randomly selected ovary under iv sedation and ultrasound control. Patients were followed with ultrasounds, estradiol, and FSH q3-4 days for two weeks. Our primary outcome was the development of new follicles &amp;gt;4mm in the treated vs. untreated ovary, using Chi-Square. Main results and the role of chance Study population description: age 33.9±5.5 years (range 21-40.4 years); BMI 23.4±4.2; FSH 96.7±27.6 mIU/mL; AMH 0.019±0.03 ng/mL; length of amenorrhea 2.2 years (3 months-14 years). 10 patients developed no follicles &amp;gt; 4 mm, 21/34 (62%) did develop follicles &amp;gt; 4 mm in treated ovaries; 9/34 (26%) developed a follicle &amp;gt; 4 mm in untreated ovaries (Chi-square = 8.59; P = 0.003). Most follicles developed without significant estradiol production; nine showed sufficient follicle development to initiate ovulation induction with initiation of gonadotropins, four produced eggs and one produced an embryo; one patient had four oocytes banked and resumed menses following PRP treatment for several months. Limitations, reasons for caution N/A Wider implications of the findings This demonstrates the first objective evidence that intraovarian PRP injections into POI ovaries initiate some follicle activation. Though the observed degree of activation was small, findings suggest that remaining follicles in women with POI can be activated through injections into ovaries, suggesting that better agents than PRP may be discovered. Trial registration number N/A

Letrozole and Clomiphene Compared With Letrozole Alone for Ovulation Induction in Women With Polycystic Ovary Syndrome: A Systematic Review and Meta-analysis [ID 2683666

INTRODUCTION: Nearly 70% of patients with polycystic ovary syndrome (PCOS) have anovulatory infertility. One therapeutic option is letrozole; however, its comparative efficacy and safety when compared with the association of letrozole and clomiphene citrate are unclear. Therefore, we aimed to compare letrozole and the combined use of letrozole and clomiphene citrate for ovulation induction in PCOS. METHODS: We systematically searched EMBASE, PubMed, and Cochrane databases for randomized controlled trials (RCTs) and observational studies comparing letrozole and clomiphene citrate versus letrozole alone in patients with PCOS. The primary endpoints rate of mature follicles and ovulation were calculated via a random-effects meta-analysis. Statistical analysis was performed using RevMan 5.4.1. Heterogeneity was assessed with I2 statistics and random-risk effect was used. RESULTS: Two RCTs and one observational study comprising 223 patients (mean age, 28.7 years; 49.3% combined therapy) were included. The combined therapy was associated with a higher number of women with mature follicles (&gt;15 mm) (odds ratio [OR] 2.94; 95% CI, 1.66–5.21; P=.0002; I2=0) and ovulations (OR 3.31; 95% CI, 1.91–5.73; P&lt;.0001; I2=0). There was no significant difference between groups in the number of pregnancies and thickness of the endometrial lining. Adverse events, including headache, abdominal bloating, fatigue, back pain, breast discomfort, and night sweats, were similar between groups. CONCLUSION: In women with PCOS and anovulatory infertility, letrozole and clomiphene citrate combined therapy promoted a significant benefit for the maturation of follicles and ovulation, with a similar safety profile compared to letrozole alone.

Comparison of Letrozole vs Clomiphene Citrate for induction of ovulation in polycystic ovarian syndromeAn Iraqi study

Polycystic ovary syndrome is a common endocrine disorder in young women and manifests as infertility in 55-75%. Clomiphene citrate is still the standard drug for inducing or augmenting ovulation. It is not, however, equally successful in all situations. L Metromile is an aromatase inhibitor and is one of the alternative treatments to Clomiphene. This study aims to answer the question (does letrozole add anything to the art Of ovulation induction and represent a real alternative to Clomiphene? To compare the effects of letrozole (5 mg) and clomiphene citrate (100 mg) for ovulation induction in women with polycystic ovary syndrome. A prospective randomized trial study was done at Tikrit Teaching Hospital. The study comprised a total of 40 infertile women with polycystic ovary syndrome; Patients were randomized to treatment with 5 mg Of letrozole daily (20 patients) or 100 mg of clomiphene citrate daily (20 patients) for 5 days starting on day 3 Of menses. Timed intercourse was advised 24-36 hours after hCG injection. Then, both groups were followed by sonography every other day from day 10 Of the menstrual cycle for the number and size Of follicles and endometrial thickness were assessed. The study revealed that the C . C group induce ovum with size &gt; 18mm 12 (60%) versus 17 (85%) among Letrzol group, while &lt; 18mm in about 8 C.C group as compared with 3 (15%) in Letrzol group, this relation was statistically not significant. The study revealed that C.C group induce &gt; 1 follicle 8 (40%) versus 2 (10%) among Letrzol group, while I follicle induced in about 6 (30%) in C.C group as compared with 16 (80%) in Letrzol group, this relation was statistically significant. The endometrium thickness was 4-5 mm in 14 (70%) among C.C group, and 17 (85%) in Letrzol group , while uterine thickness was 6-9.5mm in 6 (30%) among C.C group and 3 (15%) among Letrzol group, this relation was statistically not significant, study conclude that Letrozole should be considered as first line drug to get away from clomiphene's unwanted effects like thin endometrium and multifolliculogesis.

A comparison of letrozole regimens for ovulation induction in women with polycystic ovary syndrome

To determine the optimal letrozole regimen for ovulation induction (OI) in women with polycystic ovary syndrome (PCOS). Retrospective cohort study. Single academic fertility clinic from 2015-2022. A total of 189 OI cycles in 52 patients with PCOS. Patients were prescribed 1 of 4 letrozole regimens (group 1: 2.5 mg for 5 days, group 2: 2.5 mg for 10 days, group 3: 5 mg for 5 days, and group 4: 5 mg for 10 days). The primary outcome was ovulation, and secondary outcomes included multifollicular development, and clinical pregnancy rate, which were analyzed with binary logistic regression. Kaplan-Meier cumulative response curves and a Cox proportional hazard regression model were used for time-dependent analyses. Mean age was 30.9 years (standard deviation [SD], 3.6) and body mass index was 32.1 kg/m2 (SD, 4.0). Group 2 (odds ratio [OR], 9.12; 95% confidence interval [CI], 1.92-43.25), group 3 (OR, 3.40; 95% CI, 1.57-7.37), and group 4 (OR, 5.94; 95% CI, 2.48-14.23) had improved ovulation rates after the starting regimen as compared with group 1. Cumulative ovulation rates exceeded 84% in all groups, yet those who received 5 mg and/or 10 days achieved ovulation significantly sooner. Multifollicular development was not increased in groups 2-4 as compared with group 1. Groups 2-4 also demonstrated improved time to pregnancy. Ovulation rates are improved when starting with letrozole at 5 mg and/or a 10-day extended course as compared with the frequently-used 2.5 mg for 5 days. This may shorten time to ovulation and pregnancy.

Clomiphene citrate vs Letrozole as first line ovulation induction drug in infertile PCOS women

Background: Polycystic ovary syndrome (PCOS) is the commonest endocrinopathy resulting in anovulatory infertility in young women as in recent years have seen a significant rise in women presenting with PCOS . Despite wide acceptance of clomiphene citrate (CC) as the first-line drug for ovulation induction in women with polycystic ovaries (PCOS), a significant proportion of women do not respond to this treatment. In addition, CC use is known to have several disadvantages, including a discrepancy between ovulation and conception rates. Recent studies have suggested that letrozole, an aromatase inhibitor, can be used for ovulation induction and is associated with higher pregnancy rates and less complications than CC treatment in women with PCOs.

Efficacy of Letrozole vs Clomiphene Citrate for induction of ovulation in women with polycystic ovarian syndrome.

To compare the efficacy of letrozole vs Clomiphene citrate for ovulation induction in PCOS women. This double blind randomized controlled trial was conducted at Services Hospital, Lahore, from January 2016 to December 2020. Total 220 patients, diagnosed with PCOS according to Rotterdam criteria were randomly assigned into two groups after taking informed consent. The women were followed for ovulation, pregnancy and live birth rates in the next five consecutive menstrual cycles with either clomiphene citrate or letrozole. Letrozole had significantly better pregnancy rate (29.0% vs 15.4% p-value 0.015), monofollicular development (77.2% vs 52.7% p-value 0.000) and live birth rate (25.4% vs 10.9% p-value 0.005) as compared to clomiphene citrate. There was no difference between the two groups in ovulation rate (68.1% vs 63.6%, p-value 0.477), early pregnancy loss (3.6% vs 4.5% p-value 0.734), and twin pregnancy (0.0% vs 1.81% p-value 0.155). There was no ectopic pregnancy and no congenital anomalies in both groups. Hot flushes were higher in clomiphene group (31.8% vs 12.7% p-value 0.001) while fatigue (30.9% vs 8.1% p-value 0.000) and dizziness (21.8% vs 10.0% p-value 0.029) was higher with letrozole but these were well tolerated. Letrozole is better treatment choice than clomiphene citrate in PCOS women with infertility in terms of pregnancy and live birth rate.ClinicalTrials.gov Identifier: NCT05702957.

Effect of Letrozole and Clomiphene Citrate versus Letrozole Alone for Ovulation Induction in Women with Polycystic Ovary Syndrome

Background: Polycystic ovary syndrome (PCOS) is a common endocrinopathy characterized by oligo-ovulation or anovulation signs of androgen excess and multiple small ovarian cysts. It is thought to be one of the leading causes of female sub-fertility. It has been estimated that PCOS affects 5-10% of females in reproductive age. In this study, we used combination of letrozole and clomiphene vs letrozole alone in ovulation induction in infertile PCOS women. Objective: The objective of the study was to compare the effectiveness of the combination of letrozole and clomiphene citrate and letrozole alone in ovulation induction in infertile women with PCOS. Methods: Randomized controlled trial conducted in the Department of Reproductive Endocrinology and Infertility, Bangabandhu Sheikh Mujib Medical University, Dhaka, from July 2020 to June 2021. A total of 50 women 18-40 years of age with a diagnosis of infertility and PCOS as defined by the Rotterdam criteria and no other known cause of infertility were included in this study. Participants were randomly assigned into two groups by using a computer-generated random table to either 5 mg letrozole alone or the combination of 2.5 mg letrozole and 50 mg CC daily on cycle days 3-7 for two treatment cycle. Statistical analysis was performed by the SPSS program for Windows, version 22.0. Main outcome measured by number &amp; size of mature follicles, endometrial thickness, day 21 serum progesterone &amp; ovulation rate in both groups. The secondary outcome includes pregnancy rate and complication of both treatment arms. Results: Regarding demographic criteria, there was no significant difference between two groups. In the current study, clinical characteristics, laboratory parameters and cycle characteristics were also comparable to both groups and showed no significant difference. Dominant follicles were found 24(52.2%) in group A (CC+Letrozole) and 29(63.0%) in group B (Letrozole Alone) without any significant difference. Mono follicular development was found 18(75.0%) in group A and 24(82.8%) in group B which was not statistically significant. Endometrial thickness and serum progesterone level at 1st and 2nd cycle were not statistically significant between two groups (p&gt;0.05). Ovulation rate was higher in group B than group A (76.0% vs 72.0%) with absolute difference 4.0 and relative ratio 0.95. Pregnancy rate was also higher in group B than group A (24.0% vs 16.0%) with absolute difference 8.0 and relative ratio 0.67. Ovulation and pregnancy rate were not statistically significant between two groups. Regarding side effects, no significant difference was found between two groups. Conclusion: Although it was not statistically significant, ovulation and pregnancy rate was a little higher in alone letrozole group than combined group. The results of this preliminary study suggested that letrozole may have a better role as a first-line treatment for anovulatory patients with PCOS.

Retraction Note: Luteal phase clomiphene citrate for ovulation induction in women with polycystic ovary syndrome.

Retraction Note: Luteal phase clomiphene citrate for ovulation induction in women with polycystic ovary syndrome.

How to Choose the Optimal Starting Dose of Clomiphene Citrate (50 or 100 mg per Day) for a First Cycle of Ovulation Induction in Anovulatory PCOS Women?

Clomiphene citrate (CC) is one of the first-line treatments for ovulation induction in women with anovulatory polycystic ovary syndrome (PCOS). However, nearly 1 out of 2 women is resistant to 50 mg/day of CC. The objective of this study is to investigate the clinical, biological, and/or ultrasound factors that may predict the resistance to 50 mg/day of CC in the first cycle of treatment in women with anovulatory PCOS. This would make it possible to identify PCOS patients to whom the dose of 100 mg/day would be offered as of the first cycle. A retrospective and monocentric study was conducted on 283 women with anovulatory PCOS who required the use of ovulation induction with CC (903 cycles). During the first cycle of treatment, 104 patients (36.8%) were resistant to 50 mg/day of CC. Univariate regression analysis showed that patients who resisted 50 mg/day of CC had significantly higher BMI, waist circumference, serum levels of AMH, total testosterone, Δ4-androstenedione, 17-OHP, and insulin (p < 0.05), compared to patients ovulating with this dose. Serum levels of SHBG were significantly lower in patients resistant to 50 mg/day (p < 0.05). After multivariate analysis, only AMH and SHBG remained statistically significant (p = 0.01 and p = 0.001, respectively). However, areas under the ROC curves were weak (0.59 and 0.68, respectively). AMH and SHBG are the only two parameters significantly associated with the risk of resistance to 50 mg/day of CC. However, no satisfactory thresholds have been established to predict resistance to 50 mg CC.

A randomised double blind clinical study on effect between clomiphene citrate plus metformin and clomiphene citrate alone on induction of ovulation in women with polycystic ovarian syndrome

Polycystic ovarian syndrome (PCOS) is the most common endocrine disorder of women of reproductive age-group, characterised by a combination of hyperandrogenism, chronic anovulation, and polycystic ovaries. It is one of the most common cause of hyperandrogenism, hirsutism and anovulatory infertility. The aim of the study is to determine &amp; compare the rate of ovulation, regularisation of menstrual cycle and rate of pregnancy by use of combination of Clomiphene citrate and Metformin &amp; with use of Clomiphene citrate alone in patients with PCOS.A total 110 patients (55 in each group) having primary subfertility and diagnosed as PCOS in age group of 18 to 40 years of age, selected between April 2017 – March 2018. The primary outcome i.e, incidence of ovulation was detected by folliculometry. The secondary outcomes, i.e, regularisation of menstrual cycle &amp; Pregnancy rates were taken into account and compared in both the groups.Overall ovulation was found highest at the end of 3rd cycle of ovulation induction, 48.8% and 41% respectively in each group. The Primary outcome was significantly higher in group a given combination of clomiphene citrate and metformin (83.3%) with respect to group B given clomiphene citrate only (65.9%). The secondary outcomes were significantly higher in group given CC plus metformin (89.6%). Pregnancy rates were higher in 1st group 33.3% than 2nd group (20.5%).In the present study one group was given combination of Clomiphene citrate with metformin and another group was given clomiphene citrate only for ovulation induction. It was found that combination of clomiphene citrate and metformin was more effective in induction of ovulation in women suffering from PCOS when compared to induction of ovulation with clomiphene citrate alone.

Comparing efficacy and safety of stair step protocols for clomiphene citrate and letrozole in ovulation induction for women with polycystic ovary syndrome (PCOS): a randomized controlled clinical trial.

Polycystic ovary syndrome (PCOS) is characterized by menstrual irregularities, high androgen levels, and ovarian cysts. Clomiphene citrate (Clomid) and letrozole have both been investigated as ovulation induction therapies for PCOS. This interventional study aimed to compare the efficacy and safety of a stairstep practice of letrozole versus clomiphene citrate in women with PCOS. A total of 100 women diagnosed with PCOS and infertility participated in the study, which took place from March 2021 to July 2022 at the Maternity and Children Teaching Hospital in Adiwaniyah Province, Iraq. Participants were randomly assigned to one of two groups (each with 50 women): the first group received clomiphene citrate in a stair step pattern (single dose of 50 mg, 100 mg, and 150 mg) for five days, for a maximum of three cycles; the second group received letrozole in a stair step pattern (single dose of 2.5, 5, and 7.5 mg) for five days, for a maximum of three cycles. Follicle size was monitored using ultrasound to achieve a follicle size >18 mm. The ovulation rate was higher in the letrozole group (86.0%) compared to the clomiphene citrate group (72.0%), although the difference was not statistically significant (p=0.086). The pregnancy rate was slightly higher in the letrozole group (22.0% vs 18.0%), but also not statistically significant (p=0.617). However, the mean time from menstruation to ovulation was significantly shorter in the letrozole group (17.20±1.32 days) compared to the clomiphene citrate group (24.08 ± 1.56 days, p<0.001). There were no significant differences in common side effects between the two groups. Overall, letrozole was found to be as safe as clomiphene citrate but demonstrated a shorter time to ovulation. Further studies with larger sample sizes are necessary to validate these findings and determine their clinical implications.

Use of two insulin sensitizers in ovulation induction for women with polycystic ovary syndrome

Use of two insulin sensitizers in ovulation induction for women with polycystic ovary syndrome

Association of anti-mullerian hormone and free androgen index level on response to clomiphene citrate in PCOS infertile women

BackgroundPolycystic ovary syndrome (PCOS) is the leading cause of anovulatory infertility. Clomiphene citrate, insulin-sensitizing drugs, aromatase inhibitors, gonadotropins, or laparoscopic ovarian drilling are various methods used for ovulation induction in women with PCOS. PCOS women with high levels of anti-mullerian hormone (AMH) and free androgen index (FAI) do not respond well to ovulation induction. This prospective observational study explores the relationship between FAI and AMH levels on ovarian response to clomiphene citrate in infertile women with PCOS. MethodsThis prospective observational study included 40 infertile with PCOS who underwent ovulation induction with clomiphene citrate with dose ranging from 50 to 150 ​mg. Participants were classified into four phenotypes by NIH(National Institute of Health) consensus panel criteria. The clinical and endocrine parameters of participants who were sensitive to clomiphene were compared to those who were resistant. ResultsThe most common phenotype was A, with all three features of PCOS: hyperandrogenism, ovulatory dysfunction, and polycystic ovarian morphology. There was no significant difference in clinical and endocrine parameters among the different phenotypes of PCOS except AMH and FAI values. The mean FAI was 9.39 ​± ​1.11 and AMH 7.26 ​± ​0.48 (ng/ml) in clomiphene resistant and 5.31 ​± ​1.93 and 3.69 ​± ​1.84 (ng/ml) respectively in clomiphene-sensitive women. Women with FAI > 7.5 and AMH >7 ​ng/ml might be resistant to clomiphene. ConclusionFAI and AMH values were significantly higher in women resistant to clomiphene induction. AMH and FAI may help women with PCOS to tailor their ovulation induction protocol.

Pregnancy outcomes after oral and injectable ovulation induction in women with infertility with a low antimüllerian hormone level compared with those with a normal antimüllerian hormone level

To determine the ongoing pregnancy rate among patients with infertility with a low antimüllerian (AMH) level compared with those with a normal AMH level after oral and injectable ovulation induction (OI)/intrauterine insemination (IUI). Retrospective cohort. Academic center. Patients completing ≥1 medicated OI/IUI cycle at our center between 2015 and 2019 were included. The AMH levels were measured within 12 months of treatment initiation. The cohort was stratified into low AMH (AMH level, <1.0 ng/mL) and normal AMH (AMH level, ≥1.0 ng/mL) groups. All subsequent medicated OI/IUI cycles occurring within 1 year of initial cycle start date were included up to the third completed cycle or until an ongoing pregnancy was recorded. Patients were stratified by age (<35, 35-40, and >40 years), and the relationship between the low and normal AMH groups and each binary endpoint were quantified as risk ratios using the age-adjusted Poisson models. None. Ongoing pregnancy. A total of 3,122 patients completed 5,539 oral antiestrogen cycles, and 1,060 completed 1,630 injectable gonadotropin cycles. For oral antiestrogen treatment, pregnancy outcomes, including ongoing pregnancy rate per cycle, for patients with a low AMH level were comparable with those for patients with a normal AMH level (<35 years, 15.4% vs. 14.9%; 35-40 years, 10.0% vs. 11.0%; and >40 years, 2.8% vs. 3.3%). For injectable gonadotropin treatment, the ongoing pregnancy rate was lower in the low AMH group than in the normal AMH group for the ages of <35 (12.1% vs. 23.5%; relative risk [RR], 0.52 [95% confidence interval {CI}, 0.28-0.97]) and 35-40 (12.5% vs. 18.5%; RR, 0.70 [95% CI, 0.49-0.99]) years but comparable with that for patients aged >40 years (3.0% vs. 4.0%; RR, 0.86 [95% CI, 0.31-2.35]). The proportion of multifetal gestations was similar between the low and normal AMH groups treated with oral antiestrogens (13.1% vs. 10.8%); however, for injectable gonadotropin treatment, patients with a normal AMH level had a higher proportion of multifetal gestations (18.6% vs. 31.1%). Compared with normal ovarian reserve, treatment with oral antiestrogens for OI/IUI for patients with low ovarian reserve results in comparable follicular development and ongoing pregnancy rates for all age groups. When patients with low ovarian reserve are treated with gonadotropins for OI/IUI, multifollicular recruitment is less likely resulting in a significantly decreased ongoing pregnancy rate for patients aged <35 and 35-40 years but also a decrease in multifetal gestations. Overall, the ongoing pregnancy rates of 8.7% per oral antiestrogen cycle and 8.1% per injectable gonadotropin cycle in patients with low ovarian reserve are comparable with the expected rates in the general infertility population.

COMPARING LETROZOLE AND CLOMIPHENE CITRATE FOR OVULATION INDUCTION IN FEMALES WITH PRIMARY INFERTILITY DUE TO ANOVULATION.

Context: CC was widely used for ovulation induction in women with anovulatory infertility; aromatase inhibitors like letrozole can be used for better pregnancy outcomes in these patients. Aims: To compare the effect of CC and letrozole on ovulation induction in females with primary infertility due to anovulation. Settings and Design: An Observational study at Tertiary Health care centre, at Department of Obstetrics and Gynaecology, AVBRH, DMIMS, Sawangi (Meghe), Wardha. Methods and Material: 120 patients were divided into two equal groups. Both CC and Letrozole were given from Day 3 to Day 7 of menstrual cycle. Folliculometry was done from Day 8 on alternate days till Day 16 or till atleast one follicle reaches ≥ 18mm. Inj hCG 10,000 was given. The treatment was given for three cycles in both the groups. Main outcome measures: Ovulation Rate, Pregnancy rate, Endometrial thickness. Statistical analysis used: SPSS 24.0 version and GraphPad Prism 7.0 version. Results: The mean age, Body Mass Index (BMI), duration of infertility in both CC and Letrozole groups were similar. Ovulation rate was 72.33% in letrozole group and 63% in CC, which was not statistically signicant (p=0.17). There was statistically signicant difference between Endometrial thickness (CC 8.29±0.73, Let 9.45±0.60, p&lt;0.05, S).Monofollicular rate was more in Let than CC and this being statistically signicant (Let-76.74%, CC- 51.24%, p&lt;0.05,S). Let group had pregnancy rate as 43.33% as compared to 18.33% in CC group and this statistically signicant (p&lt;0.05,S). Conclusions: Present study showed that Letrozole had better pregnancy rates than CC. Letrozole can be used as a choice of drug for ovulation induction in females with infertility due to anovulation.

Aromatase inhibitors (letrozole) for ovulation induction in infertile women with polycystic ovary syndrome.

Aromatase inhibitors (letrozole) for ovulation induction in infertile women with polycystic ovary syndrome.

Induction of ovulation in women with PCOS using letrozole versus letrozole plus gonadotropin and its effect on spontaneous on going pregnancy rate through multicenter IVF in Beni-Suef city using randomized controlled study

Background: We developed a multicenter randomized observational trial to assess the effectiveness of letrozole monotherapy and the co-therapy of letrozole and gonadotropins on pregnancy outcomes including the ovulation induction, pregnancy rate, estradiol (E2) levels and endometrial thickness in infertile women with polycystic ovarian syndrome (PCOS).Methods:At three in vitro fertilization (IVF) centers in Egypt, we conducted our study since May 2019 until we have recruited the planned number of patients. Infertile PCOS patients were recruited after they met our criteria. We had two intervention groups based on the treatment regimen.Moreover, baseline parameters, outcomes, and hormonal assessment was conducted throughout the study period. Results: We included 90 patients in this study and were equally randomized into two groups; the letrozole monotherapy (Group A) and the letrozole with gonadotropins (Group B) groups. The mean age was significantly higher in group A [26 (±3.5)] than group B [24.2 (±3.1)] (P= 0.015). Both groups showed resulted in similar pregnancy rates (31.1%) (P= 0.079).Moreover, group B [2.4 (±0.8)] resulted in a significantly higher (P= 0.023) mean number of follicles than group A [2.0 (±0.7)]. On the other hand, no statistical significance was estimated in terms of estradiol levels and endometrial thickness (P= 0.209 and 0.485, respectively).