Shuo Huang1, Xiaoguo Du1, Rui Wang2, Rong Li1, Haiyan Wang1, Li Luo1, Sean O'Leary2, Jie Qiao3, Ben Willem J Mol4. 1. Center of Reproductive Medicine, Department of Obstetrics and Gynaecology, Peking University Third Hospital, Beijing, China. 2. Robinson Research Institute and Adelaide Medical School, University of Adelaide, Adelaide, Australia. 3. Center of Reproductive Medicine, Department of Obstetrics and Gynaecology, Peking University Third Hospital, Beijing, China. Electronic address: jie.qiao@263.net. 4. Department of Obstetrics and Gynaecology, Monash Medical Centre, Monash Health and Monash University, Clayton, Australia.
Abstract
OBJECTIVE: To study the effectiveness of different ovulation induction protocols in infertile women with polycystic ovary syndrome (PCOS) undergoing intrauterine insemination (IUI). DESIGN: Retrospective cohort study. PATIENTS: Infertile women with PCOS undergoing IUI had ovulation induced with clomiphene citrate (CC), letrozole, or gonadotropins. MAIN OUTCOME MEASURE: Live birth and multiple pregnancy rates. RESULTS: We performed 1068 IUI cycles in 765 couples. Live birth rates were comparable in CC-stimulated cycles (13.9%), letrozole-stimulated cycles (13.5%, OR 0.96 [95% CI, 0.63, 1.47]), and gonadotropins-stimulated cycles (13.2%, OR 0.94[95% CI, 0.62, 1.43]). Multiple pregnancy rates were 8.3%, 4.1% (OR 0.47 [95% CI, 0.09, 2.42]), and 3.3% (OR 0.34 [95% CI, 0.07, 1.95]) in CC, letrozole and gonadotropins stimulated cycles, respectively. Compared to CC, letrozole generated more often mono-follicular growth (75.9% versus 67.0%; OR 1.55 [95% CI, 1.11, 2.15]) but not more often after gonadotropins (72.9%, OR 1.17 [95% CI, 0.82, 1.66]. Cycles with multi-follicular growth did not result in statistically higher live birth rates than cycles with mono-follicular growth (15.8% vs. 12.7%, OR 1.29 [95% CI 0.89, 1.89]), but more often in multiple pregnancies (15.5% versus 0.8%, OR 22.4 [95% CI, 2.8, 181.6]). CONCLUSION: In women with PCOS undergoing stimulated IUI, CC, letrozole and gonadotropins were equally effective and safe. Since multi-follicular growth increased the multiple pregnancy rates without increasing the overall live birth rate, ovulation induction would strictly aim for mono-follicular growth. Since letrozole had the highest mono-follicular growth rate, we recommend this drug as the treatment of first choice in infertile women undergoing ovulation induction and IUI.
OBJECTIVE: To study the effectiveness of different ovulation induction protocols in infertile women with polycystic ovary syndrome (PCOS) undergoing intrauterine insemination (IUI). DESIGN: Retrospective cohort study. PATIENTS: Infertile women with PCOS undergoing IUI had ovulation induced with clomiphene citrate (CC), letrozole, or gonadotropins. MAIN OUTCOME MEASURE: Live birth and multiple pregnancy rates. RESULTS: We performed 1068 IUI cycles in 765 couples. Live birth rates were comparable in CC-stimulated cycles (13.9%), letrozole-stimulated cycles (13.5%, OR 0.96 [95% CI, 0.63, 1.47]), and gonadotropins-stimulated cycles (13.2%, OR 0.94[95% CI, 0.62, 1.43]). Multiple pregnancy rates were 8.3%, 4.1% (OR 0.47 [95% CI, 0.09, 2.42]), and 3.3% (OR 0.34 [95% CI, 0.07, 1.95]) in CC, letrozole and gonadotropins stimulated cycles, respectively. Compared to CC, letrozole generated more often mono-follicular growth (75.9% versus 67.0%; OR 1.55 [95% CI, 1.11, 2.15]) but not more often after gonadotropins (72.9%, OR 1.17 [95% CI, 0.82, 1.66]. Cycles with multi-follicular growth did not result in statistically higher live birth rates than cycles with mono-follicular growth (15.8% vs. 12.7%, OR 1.29 [95% CI 0.89, 1.89]), but more often in multiple pregnancies (15.5% versus 0.8%, OR 22.4 [95% CI, 2.8, 181.6]). CONCLUSION: In women with PCOS undergoing stimulated IUI, CC, letrozole and gonadotropins were equally effective and safe. Since multi-follicular growth increased the multiple pregnancy rates without increasing the overall live birth rate, ovulation induction would strictly aim for mono-follicular growth. Since letrozole had the highest mono-follicular growth rate, we recommend this drug as the treatment of first choice in infertile women undergoing ovulation induction and IUI.
Authors: Vu Ngoc Anh Ho; Toan Duong Pham; Nam Thanh Nguyen; Hieu Le Trung Hoang; Tuong Manh Ho; Lan Ngoc Vuong Journal: Clin Exp Reprod Med Date: 2022-05-27
Authors: Natalie Dayan; Maria P Velez; Simone Vigod; Jessica Pudwell; Maya Djerboua; Deshayne B Fell; Olga Basso; Tuong Vi Nguyen; K S Joseph; Joel G Ray Journal: CMAJ Open Date: 2022-05-17