Outcome of treatment with letrozole versus gonadotrophins stimulated IUI (Intrauterine Insemination) in the management of unexplained infertility.

Abstract

Objective: To compare the outcome of treatment in patients with primary unexplained infertility with gonadotrophin v/s letrozole stimulated IUI (intrauterine insemination). Study Design: Prospective Experimental study. Setting: Obstetrics and Gynaecology Department of Al- Shifa Healthcare Group, Al- Shifa Multi Speciality Medical Centers, Sharjah, United Arab Emirates. Period: October 2022 till April 2023. Methods: 110 patients of primary unexplained infertility were included in this study who were randomly divided into 2 groups and were treated with stimulated IUI. One group was stimulated with Gonadotrophin, Gonal-f, while, the other was treated with letrozole, an oral anti-estrogen. Ovarian response was noted in the form of 2 dominant follicles of 18-22 mm in diameter, in whom, ovulation was triggered with 250 mcg of choriogonadotrophin-alpha. Patients who did not had menstruation on the expected date, were tested for pregnancy 1 week after missing the due date of menstruation. Statistically significant parameters were recorded between the 2 groups (serum AMH value, FSH value, BMI and Age) with and without ovulation and pregnancy. Results: In the letrozole treated group; 28 out of 55 patients responded in the form of adequate ovarian response, whereas 27 patients did not attain adequate ovarian response. Among the 28 ovulating patients 12 got pregnant being 21.8 % of total letrozole treated women. Regarding gonadotrophin group, 44 out of 55 patients had an adequate ovarian response, being 80 % and only 11 patients could not attain an adequate ovarian response. Out of ovulating patients, pregnancy was achieved in 27 patients being 49.09%. Conclusion: Among the women with unexplained infertility of primary origin, treated with stimulated Intra-Uterine Insemination with gonadotrophins and letrozole, ovulation as well as pregnancy rates were significantly higher among the patients who were treated with gonadotrophins for controlled ovarian stimulation, in terms of ovulation as well as pregnancy rates, as compared to letrozole treated patient. Moreover, regarding the outcomes measured in this study; ovulation as well as pregnancy, both are seen to be higher among the younger ages, high AMH, low FSH, low basal LH and low BMI patients.