| Objective: The objective of this retrospective study was conducted to to understand clinical characteristics of ovarian stimulation with letrozole and determine the clinical pregnancy outcome in women with letrozole ovarian stimulation in artificial insemination by donor(AID)through statistically analysis of clinical data collected from patients undergoing AID for infertility at Tongji Hospital.Method: In this study,130 natural cycles with serum LH≥30 m IU/ml on HCG day,939 letrozole cycles and 130 letrozole plus gonadotropin(Gn)cycles were included from December 2012 to December 2015 in university hospital-based reproductive medecine center.The 130 natural cycles were selected for inclusion in the study based on matching for age,baseline FSH and baseline LH with the 130 cycles with serum LH≥30 m IU/ml on HCG day in the LE group.Letrozole was given in a dose of 2.5-5mg daily for 5 days starting on days 3-5 of the menstrual cycle.Gn injections were given in the form of r FSH or u FSH after day 9 of menstrual cycle and the dose was adjusted according to the follicle response.Monitoring in every cycle included day 3 to 5 baseline serum LH and FSH levels.From cycle day 10 onward,ovarian ovulation was monitored regularly with a transvaginal ultrasound to determine leading diameter of growing follicles.This was recorded along with the endometrial thickness and serum LH and E2.The blood samples were drawn between 08:00 and 09:00.The primary outcome was clinical pregnancy rate.The secondary outcomes were biochemical pregnancy rate,ectopic pregnancy rate and multiple pregnancy rate.The main measurements were serum LH level,E2,endometrial thickness and follicle size on HCG day.Luteal support was applied.Results: The overall pregnancy rate was 21.7% per cycle in letrozole group.Letrozole cycles were divided into three groups by luteinizing hormone before human chorionic gonadotropin administration: group 1,patients who had LH<10 m IU/ml with follicle size≥18mm;group 2,patients with 10≤LH<20 m IU/ml;group 3,patients with LH≥20 m IU/ml.The biochemical pregnancy rates were 18.9%,26.7% and 32.1% respectively in three groups(P<0.001).The pregnancy rates were 17.3%,22.4% and 26.8% in three groups respectively(P=0.012).Pregnancy rate with LH<10 m IU/ml was significantly lower than the rates with LH≥20 m IU/ml.In letrozole group with LH≥10 m IU/ml group,logistic regression identified estradiol(OR=1.002,95%CI,1.000-1.004,P=0.026)and leading follicle size(OR=0.859,95%CI,0.770-0.958,P=0.006)as significant predictive factors of clinical pregnancy rate(PR);and the higher the estradiol and the smaller the follicles size,the better the PR.The clinical pregnancy rate was significantly higher in letrozole plus Gonadotropin group than letrozole group(P=0.04).There was no significant difference in biochemical pregnancy rate between two groups.In women undergoing artificial intrauterine insemination by donor,twin deliveries occurred in 1.14% in letrozole group and 1.54% in letrozole plus Gn group without statistically significant difference.Conclusions: In conclusion,better clinical pregnancy rate can be achieved if LH surge occurs before HCG administration,especially with higher estradiol and smaller follicle size;treatment with letrozole plus Gn was significantly more effective than letrozole alone in artificial intrauterine insemination by donor. |
PDF Full Text Request