06Apr 2018

DUAL OVULATION TRIGGERING WITH FOLLICLE-STIMULATING HORMONE AND HUMAN CHORIONIC GONADOTROPIN IN WOMEN WITH UNEXPLAINED INFERTILITY UNDERWENT LETROZOLE SUPEROVULATION AND INTRAUTERINE INSEMINATION: A RANDOMIZED CONTROLLED TRIAL.

  • Benha Faculty of Medicine, Farid Nada Street, Benha, Alkalubia, Egypt.
Crossref Cited-by Linking logo

  • Abstract
  • Keywords
  • References
  • Cite This Article as
  • Corresponding Author

Objectives: TO determine whether a supplementary follicle-stimulating hormone (FSH) bolus given at the time of the human chorionic gonadotropin (hCG) trigger can improve the pregnancy and live birth rates in women with unexplained infertility (UI) underwent letrozole stimulated intrauterine insemination (IUI). Design: A randomized controlled trial. Patients and methods: One-hundred and eight women with primary unexplained infertility underwent combined letrozole superovulation and IUI. At the time of ovulation triggering patients were randomized into hCG trigger alone (Control group) versus combined FSH plus hCG trigger (Study group). Primary outcome included the clinical pregnancy and the live birth rates. Secondary outcomes included the frequency of ovarian hyperstimulation syndrome (OHSS), multiple gestations, and abortion. Results: Significantly higher pregnancy rates pre-cycle (12.5% vs. 5.8%: p=0.049) and per-woman (33.33% vs. 16.67%: p=0.049) and live birth rate (29.6% vs. 12.5%; p= 0.039) were noted in the study group compared to the control group. Abortion occurred in 2 out of 18 pregnancies (11.11 %) in the study group and in 2 out of 9 pregnancies (22.22 %) in the control group with no significant difference. No case of multiple gestations or OHSS reported in either group. Conclusion: Ovulation trigger with the dual administration of FSH and hCG compared to hCG alone significantly increased clinical pregnancy rate and the live birth rate in women with unexplained infertility underwent combined letrozole superovulation and IUI.

  1. Kamath MS, Bhattacharya S: Demographics of infertility and management of unexplained infertility. Best Pract Res Clin Obstet Gynaecol. 2012; 26(6):729-38.
  2. Veltman-Verhulst SM, Hughes E, Ayeleke RO, Cohlen BJ. Intrauterine insemination for unexplained subfertility. Cochrane Database Syst Rev. 2016 Feb 19; 2:CD001838. doi: 10.1002/14651858.CD001838.pub5.
  3. Kamath MS, Bhave P, Aleyamma T, Nair R, Chandy A, Mangalaraj AM, et al. Predictive factors for pregnancy after intrauterine insemination: A prospective study of factors affecting outcome. J Hum Reprod Sci 2010; 3:129-34.
  4. Requena A, Herrero J, Landeras J et al. Use of letrozole in assisted reproduction: a systematic review and meta-analysis. Hum Reprod Update. 2008 Nov-Dec; 14(6):571-82.
  5. Bedaiwy MA , Abdelaleem MA, Hussein M et al. Hormonal, follicular and endometrial dynamics in letrozole-treated versus natural cycles in patients undergoing controlled ovarian stimulation. Reprod Biol Endocrinol. 2011 Jun 21; 9:83.
  6. Hoff JD, Quigley ME, Yen SS. Hormonal dynamics at midcycle: a reevaluation. Journal Clin Endocrinol Metab 1983; 57:792?6.
  7. Fauser BC, de Jong D, Olivennes F, et al. Endocrine profiles after triggering of final oocyte maturation with GnRH agonist after cotreatment with the GnRH antagonist ganirelix during ovarian hyperstimulation for in vitro fertilization. J Clin Endocrinol Metab. 2002; 87:709?15
  8. Kol S, Humaidan P. LH (as HCG) and FSH surges for final oocyte maturation: sometimes it takes two to tango? Reprod Biomed Online. 2010 Nov; 21(5):590-2.
  9. Dmowski WP, Rezai P, Auletta FJ, Scommegna A. Abnormal follicle-stimulating hormone and luteinizing hormone patterns contrasting with normal estradiol and progesterone secretion in women with longstanding unexplained infertility. J Clin Endocrinol Metab. 1981 Jun; 52(6):1218-24.
  10. Cooper TG, Noonan E, von Eckardstein S. World Health Organization reference values for human semen characteristics. Hum Reprod Update. 2010; 16(3):231-45.
  11. Ibrahim MI, Moustafa RA, Abdel-Azeem AA. Letrozole versus clomiphene citrate for superovulation in Egyptian women with unexplained infertility: a randomized controlled trial. Arch Gynecol Obstet. 2012 Dec; 286(6):1581-7.
  12. Mitwally MF, Casper RF. Aromatase inhibition reduces gonadotrophin dose required for controlled ovarian stimulation in women with unexplained infertility. Hum Reprod 2003; 18: 1588-97.
  13. Barroso G, Menocal G, Felix H et al. Comparison of the efficacy of the aromatase inhibitor letrozole and clomiphene citrate as adjuvants to recombinant follicle-stimulating hormone in controlled ovarian hyperstimulation: a prospective, randomized, blinded clinical trial. Fertil Steril. 2006 Nov; 86(5):1428-31.
  14. Badawy A, Elnashar A, Totongy M. Clomiphene citrate or aromatase inhibitors combined with gonadotropins for superovulation in women undergoing intrauterine insemination: a prospective randomised trial. J Obstet Gynaecol. 2010; 30(6):617-21.
  15. Fouda UM, Sayed AM. Extended letrozole regimen versus clomiphene citrate for superovulation in patients with unexplained infertility undergoing intrauterine insemination: a randomized controlled trial. Reprod Biol Endocrinol 2011; 9: 84.
  16. Diamond MP, Legro RS, Coutifaris C et al. Letrozole, Gonadotropin, or Clomiphene for Unexplained Infertility. N Engl J Med. 2015 Sep 24; 373(13):1230-40.
  17. Lamb JD, Shen S, McCulloch C et al. Follicle-stimulating hormone administered at the time of human chorionic gonadotropin trigger improves oocyte developmental competence in in vitro fertilization cycles: a randomized, double-blind, placebo-controlled trial. Fertil Steril. 2011 Apr; 95(5):1655-60.
  18. Vermeiden JP, Roseboom TJ, Goverde AJ, Suchartwatnachai C, Schoute E, Braat DD, Schats R. An artificially induced follicle stimulating hormone surge at the time of human chorionic gonadotrophin administration in controlled ovarian stimulation cycles has no effect on cumulus expansion, fertilization rate, embryo quality and implantation rate. Hum Reprod. 1997 Jul; 12(7):1399-402.
  19. Juneau CR, Morin SJ, Franasiak JM, Landis JN, Molinaro TA, Scott RT. A ?follicle-stimulating hormone boost? administered at the time of human chorionic gonadotropin trigger does not affect IVF cycle outcomes. Fertil Steril. 2016; 106(3): e189?e190
  20. Yding Andersen C. Effect of FSH and its different iso-forms on maturation of oocytes from pre-ovulatory follicles. Reprod Biomed Online 2002; 5(3):232?9.
  21. Bianchi V, Dal Prato L, Maccolini A, Mazzone S, Borini A. Inadvertent recombinant human follicle stimulating hormone bolus instead of human chorionic gonadotrophin leads to the retrieval of competent oocytes in IVF program. Fertil Steril. 2009 Nov; 92(5):1747.e1-3. doi: 10.1016/j.fertnstert.2009.07.998. Epub 2009 Sep 3.
  22. Abdalla HI, Ah-Moye M, Brinsden P, Howe DL, Okonofua F, Craft I, The effect of the dose of human chorionic gonadotropin and the type of gonadotropin stimulation on oocyte recovery rates in an in vitro fertilization program, Fert. Steril. 48 (6): 1987; 958?963.
  23. Shaltout AA, Eid MS, Shohayeb AA. Does triggering ovulation by 5000 IU of uhCG affect ICSI outcome?, Middle East Fert Soc. J. 11 (2): 2006; 99?103.
  24. Wilcox AJ, Baird DD, Weinberg CR.? Time of implantation of the conceptus and loss of pregnancy. N Engl J Med 1999; 340: 1796-1799.
  25. Pezeshki K, Feldman J, Sten DE, Lobel SM, Grazi RV. Bleeding and spontaneous abortion after therapy for infertility. Fertil Steril 2000; 74: 504-508.

[Ahmed Walid Anwar Morad. (2018); DUAL OVULATION TRIGGERING WITH FOLLICLE-STIMULATING HORMONE AND HUMAN CHORIONIC GONADOTROPIN IN WOMEN WITH UNEXPLAINED INFERTILITY UNDERWENT LETROZOLE SUPEROVULATION AND INTRAUTERINE INSEMINATION: A RANDOMIZED CONTROLLED TRIAL. Int. J. of Adv. Res. 6 (Apr). 456-463] (ISSN 2320-5407). www.journalijar.com

Ahmed Walid Anwar Morad
Assistant Professor, Department of Obstetrics and Gynecology, Faculty of Medicine; Benha University; Egypt

DOI:

Article DOI: 10.21474/IJAR01/6879      
DOI URL: https://dx.doi.org/10.21474/IJAR01/6879

Download Full Paper

Download PDF No. of Downloads: 27 | No. of Views: 168