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Prospective,
Randomized, Comparative Clinical Study of the Efficacy of Letrozole
and Clomiphene Citrate as Adjuvants to Follicle-Stimulating Hormone
in Superovulation
Zakaria Sanad1, Hamid Ellakwa1, Sherif Abd
El-Salam1, Said Saleh1, Tarek Sayed1,
Osama El-Kelani1, Mehany Abd El-Sattar1 & Dina
El-Khouli2
Obstetrics & Gynecology Departments, Faculty of Medicine, Menoufiya1
and Tanta2 Universities, Egypt
Tanta Med. Sc. J 2008; 3(3):127-133
Article type: Original article
Aim: Prospective, randomized, comparative
clinical study to compare the efficacy of the aromatase inhibitor
letrozole and clomiphene citrate (CC) as adjuvants to
follicle-stimulating hormone (FSH) in superovulation. Patients &
Methods: A total of 120 patients from outpatient clinic of Menoufiya
University hospital with unexplained or mild male factor infertility
were randomized to receive either letrozole (59 patients) or CC (61
patients) as adjuvants to FSH. From day 3 to 7 of the cycle 2.5 mg/d
letrozole or 100 mg/d CC were administered followed by 75 IU/d FSH
starting on day 7 until the day of human chorionic gonadotropin
(hCG). Ovulation was triggered with 10,000 IU of hCG when the
leading follicle (s) reached 18 mm in diameter. A single
intrauterine insemination (IUI) was performed 36 h later. Ovarian
(estradiol (E2) levels and number of follicles) and endometrial
(endometrial thickness) response and pregnancy outcome were the main
measures. Results: The number of mature preovulatory follicles (1.9
+ 0.7 vs. 2.2 + 0.5, P<0.0001) and the peak E2 level (791 + 163 vs.
1137 + 192 pg/ml, P<0.0001) were significantly higher in the CC
group than in the letrozole group. A significantly higher
endometrial thickness was observed on the day of hCG in the
letrozole group (9.1 + 1.2 vs. 7.7 + 1.4 mm, P<0.0001). There was no
significant difference between groups in clinical pregnancy rates
(38.4% in the letrozole and 31.3% in the CC groups). In contrast,
the abortion rate was significantly higher in the CC group (42% vs.
13%, P=0.04). Conclusion: The aromatase inhibitor letrozole appears
to be a good alternative to CC in superovulation therapy. Benefits
of letrozole observed in this study were the achievement of a lower
number of mature follicles and a higher endometrial thickness as
well as a similar pregnancy rate and a lower miscarriage rate
compared with CC.
ICID 874414
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