Volume 9, Issue 1 (7-2011)                   IJRM 2011, 9(1): 0-0 | Back to browse issues page

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Davar R, Javedani M, Fallahzadeh M H. Metformin-letrozole in comparison with Metformin-clomiphene citrate in clomiphene-resistance PCOS patients undergoing IUI. IJRM 2011; 9 (1)
URL: http://ijrm.ir/article-1-200-en.html
Metformin-letrozole in comparison with Metformin-clomiphene citrate in clomiphene-resistance PCOS patients undergoing IUI
Robab Davar * 1, Mojgan Javedani2 , Mohammad Hossein Fallahzadeh3
1- Research and Clinical Center for Infertility, Shahid Sadoughi University of Medical Sciences, Yazd, Iran , r_davar@yahoo.com
2- Research and Clinical Center for Infertility, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
3- Department of Biostatistics and Epidemiology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
Abstract:   (6037 Views)
Background: Polycystic ovary syndrome (PCOS) is associated with approximately 75% of women who suffer from infertility due to anovulation. Additionally, around 20– 25% of anovulatory women with PCOS do not respond at all to clomiphene citrate and are considered to be “clomiphene– resistant”. Aromatase inhibitors have been suggested as an alternative treatment to clomiphene as the discrepancy between ovulation and pregnancy rates with clomiphene citrate has been attributed to its anti-estrogenic action and estrogen receptor depletion.
Objective: The aim of this study is to compare results of Metformin-letrozole with Metformin-clomiphene citrate in clomiphene resistance PCOS patients undergoing IUI.
Materials and Methods: In this single blind randomized trial, ovarian cycles were studied in 100 clomiphene- resistant patients with PCOS. The inclusion criteria were patients who received 150mg clomiphene citrate daily for 3 cycles and failed to become pregnant. The patients were matched for their age, body mass index (BMI), and infertility period. They were randomly allocated to a metformin-letrozole group (n=50) and a metformin-clomiphene citrate group (n=50). Chemical and clinical pregnancies were assessed after IUI. Abortion rates were determined in both groups.
Results: Regarding pregnancy rate, there was no significant difference between the two groups. One miscarriage (2%) occurred in the metformin-clomiphene citrate group, whereas none was seen in the metformin-letrozole group.
Conclusion: There is no significant difference in pregnancy rate between clomiphene citrate and letrozole groups although it has been 2% in the former and 5% in the latter. Article
Keywords: Letrozole, Clomiphene citrate, Ovarian stimulation, PCO, IUI, Metformin
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Type of Study: Original Article |
References
1. Gordon P, Treasure JL, King EA, Wheeler M, Russell GF. Prevalence of polycystic ovaries in women with anovulation and idiopathic hirsutism. Br Med J (Clin Res Ed) 1986; 293: 956-957. [DOI:10.1136/bmj.293.6552.956-c]
2. Hull MG. Epidemiology of infertility and polycystic ovarian disease: endocrinological and demographic studies. Gynecol Endocrinol 1987; 1: 235-245. [DOI:10.3109/09513598709023610]
3. Gysler M, March CM, Mishell DR Jr, Bailey EJ. A decade's experience with an individualized clomiphene treatment regimen including its effect on the postcoital test. Fertil Steril 1982; 37: 161-167. [DOI:10.1016/S0015-0282(16)46033-4]
4. Macgregor AH, Johnson JE, Bunde CA. Further clinical experience with clomiphene citrate. Fertil Steril 1968; 19: 616-622. [DOI:10.1016/S0015-0282(16)36736-X]
5. Imani B, Eijkemans MJ, te Velde ER, Habbema JD, Fauser BC. A nomogram to predict the probability of live birth after clomiphene citrate induction of ovulation in normogonadotropic oligoamenorrheic infertility. Fertil Steril 2002; 77: 91-97. [DOI:10.1016/S0015-0282(01)02929-6]
6. Franks S, Hamilton-fairley D. Ovulation Induction: Gonadotrophins. In: Reproductive Endocrinology, Surgery and Technology 1996; Philadelphia, Lippincott-Raven.
7. Imani B, Eijkemans MJ, TE Velde ER, Habbema JD, Fauser BC. Predictors of patients remaining anovulatory during clomiphene citrate induction of ovulation in normogonadotropic oligoamenorrheic infertility. J Clin Endocrinol Metab 1998; 83: 2361-2365. [DOI:10.1210/jc.83.7.2361]
8. Hakim RB, Gray RH, Zacur H. Infertility and early pregnancy loss. Am J Obstet Gynecol 1995; 172: 1510-1517. [DOI:10.1016/0002-9378(95)90489-1]
9. Check JH, Dietterich C, Lurie D. The effect of consecutive cycles of clomiphene citrate therapy on endometrial thickness and echo pattern. Obstet Gynecol 1995; 86: 341-345. [DOI:10.1016/0029-7844(95)00165-N]
10. Gonen, Y, Casper RF. Sonographic determination of a possible adverse effect of clomiphene citrate on endometrial growth. Hum Reprod 1990; 5: 670-674. [DOI:10.1093/oxfordjournals.humrep.a137165]
11. ben-ami M, Geslevich Y, Matilsky M, Battino S, Weiner E, Shalev E. Exogenous estrogen therapy concurrent with clomiphene citrate--lack of effect on serum sex hormone levels and endometrial thickness. Gynecol Obstet Invest 1994; 37: 180-182. [DOI:10.1159/000292554]
12. Nelson LM, Hershlag A, Kurl RS, Hall JL, Stillman RJ. Clomiphene citrate directly impairs endometrial receptivity in the mouse. Fertil Steril 1990; 53:727-731. [DOI:10.1016/S0015-0282(16)53472-4]
13. LI TC, Warren MA, Murphy C, Sargeant S, Cooke IDA. Prospective, randomised, cross-over study comparing the effects of clomiphene citrate and cyclofenil on endometrial morphology in the luteal phase of normal, fertile women. Br J Obstet Gynaecol 1992; 99: 1008-1013. [DOI:10.1111/j.1471-0528.1992.tb13708.x]
14. Mitwally MF, Casper RF. Use of an aromatase inhibitor for induction of ovulation in patients with an inadequate response to clomiphene citrate. Fertil Steril 2001; 75: 305-309. [DOI:10.1016/S0015-0282(00)01705-2]
15. Mitwally MF, Casper RF. Aromatase inhibition improves ovarian response to follicle-stimulating hormone in poor responders. Fertil Steril 2002b; 77: 776-780. [DOI:10.1016/S0015-0282(01)03280-0]
16. Mitwally MF, Casper RF. Single-dose administration of an aromatase inhibitor for ovarian stimulation. Fertil Steril 2005; 83: 229-231. [DOI:10.1016/j.fertnstert.2004.07.952]
17. Mitwally MF, Biljan MM, Casper RF. Pregnancy outcome after the use of an aromatase inhibitor for ovarian stimulation. Am J Obstet Gynecol 2005; 192: 381- 386. [DOI:10.1016/j.ajog.2004.08.013]
18. AL-Fozan H, AL-Khadouri M, Tan SL, Tulandi TA. Randomized trial of letrozole versus clomiphene citrate in women undergoing superovulation. Fertil Steril 2004; 82: 1561-1563. [DOI:10.1016/j.fertnstert.2004.04.070]
19. Fisher SA, Reid RL, Van vugt DA, Casper RF. A randomized double-blind comparison of the effects of clomiphene citrate and the aromatase inhibitor letrozole on ovulatory function in normal women. Fertil Steril 2002; 78: 280-285. [DOI:10.1016/S0015-0282(02)03241-7]
20. Sammour A, Biljan MM, Tan SL, Tulandi T. Prospective randomized trial comparing the effects of letrozole and clomiphene citrate on follicular development, endometrial thickness, and pregnancy rate in patients undergoing superovulation prior to intrauterine insemination. Fertil Steril 2001; 76: S110. [DOI:10.1016/S0015-0282(01)02323-8]
21. Mitwally MF, Casper RF. Aromatase inhibition for ovarian stimulation: future avenues for infertility management Curr Opin Obstet Gynecol 2002a; 14: 255-263. [DOI:10.1097/00001703-200206000-00003]
22. Fleming R, Hopkinson ZE, Wallace AM, Greer IA, Sattar N. Ovarian function and metabolic factors in women with oligomenorrhea treated with metformin in a randomized double blind placebo-controlled trial. J Clin Endocrinol Metab 2002; 87:569-574. [DOI:10.1210/jcem.87.2.8261]
23. Heard MJ, Pierce A, Carson SA, Buster JE. Pregnancies following use of metformin for ovulation induction in patients with polycystic ovary syndrome. Fertil Steril 2002; 77: 669-673. [DOI:10.1016/S0015-0282(01)03266-6]
24. Nestler JE, Jakubowicz DJ, Evans WS, Pasquali R. Effects of metformin on spontaneous and clomiphene-induced ovulation in the polycystic ovary syndrome. N Engl J Med 1998; 338: 1876-1880. [DOI:10.1056/NEJM199806253382603]
25. Bast RC, Kufe DW, Pollock RE, Weichselbaum RR. Cancer Medicine: abnormal mammogram.5th edition. Holland: Hamilton; 2000.
26. Sohrabvand F, Ansari S, Bagheri M. Efficacy of combined metformin-letrozole in comparison with metformin-clomiphene citrate in clomiphene-resistant infertile women with polycystic ovarian disease. Hum Reprod 2006; 21: 1432-1435. [DOI:10.1093/humrep/del020]
27. David K Gardner,ArielWeissman, Colin M Howles, Zeev Shoham. Textbook of assisted reproductive technologies. 3rd Ed. United Kingdom; Informa Healthcare; 2009.
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