ISSN: 2148-8274 / E-ISSN: 2587-0084
, Türk Üreme Tıbbı ve Cerrahisi
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Turkish Journal of Reproductive Medicine and Surgery

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ORİJİNAL ARAŞTIRMALAR

Letrozol ve Klomifen Sitrat Birlikteliğinin Açıklanamayan İnfertil Hastalardaki Etkinliği
The Efficacy of Combination of Letrozole and Clomiphene Citrate in Unexplained Infertile Patients
Received Date : 20 Feb 2023
Accepted Date : 27 Apr 2023
Available Online : 03 May 2023
Doi: 10.24074/tjrms.2023-96222 - Makale Dili: TR
TJRMS. 2023;7(1):11-6
ÖZET
Amaç: Çalışmamızda açıklanamayan primer infertilite tanılı hastaların tedavisinde klomifen sitrat (CC), aromataz inhibitörü (letrozol) ve letrozol ile CC birlikte kullanılarak ovulasyon indüksiyonu ve intrauterin inseminasyon (IUI) yapılan hasta gruplarının karşılaştırılması hedeflenmiştir. Gereç ve Yöntemler: Çocuk istemiyle müracaat eden, açıklanamayan infertilite tanısı konmuş 90 primer infertil çift ile yapılan bir çalışmadır. Hastalar ovulasyon indüksiyonunda kullanılacak ajana göre 3 gruba ayrıldı. 1. grup; CC ve letrozol; 2. Grup yalnızca letrozol ve 3. Grup ise yalnızca CC ile tedavi edildi. Dominant follikül gelişen hastalarda 6500 IU koryogonadotropin-alfa ile ovulasyon tetiklendi. Ovulasyondan yaklaşık 36-38 saat sonra IUI işlemi yapıldı. Takiplerde β-hCG değeri pozitif gelen ve fetal kalp atımı olan gebelikler kaydedildi. Bulgular: Gruplar arasında IUI günü bakılan estradiol artış miktarlarında ve endometrial kalınlıklarında anlamlı fark bulunmadı. Ovulasyon indüksiyonu zamanında kombine tedavi alan ilk grupta 14-18 mm arası folikül sayısı 2, diğer iki grupta ise 1 olarak bulundu ancak dominant follikül sayısına bakıldığında (>18 mm) gruplar arasında istatistiksel fark bulunmadı. Gebelik oranları bakımından 3 grup arasında istatistiksel olarak anlamlı fark saptanmadı. Sonuç: CC ve letrazol ile kombine, yalnız CC ve yalnız letrozol ile ovulasyon indüksiyonu ve IUI yapılmış hastalarda gruplar arasında gebelik oranları açısından birbirlerine üstünlükleri görülmemiştir.
ABSTRACT
Objective: We aimed to compare the patient groups who underwent ovulation induction and intrauterine insemination (IUI) by using clomiphene citrate (CC), aromatase inhibitor (letrozole), and letrozole together with CC in the treatment of patients with unexplained primary infertility. Materials and Methods: This study was conducted on 90 primary infertile couples who were diagnosed with unexplained infertility and applied with the desire to have children. The patients were divided into 3 groups according to the agent to be used in ovulation induction. 1st group; CC and letrozole; Group 2 was treated with letrozole only, and Group 3 was treated with CC only. Ovulation was triggered with 6500 IU choriogonadotropin- alpha in patients who have dominant follicles. IUI procedure was performed approximately 36-38 hours after ovulation. During the follow- up, pregnancies and fetal heartbeat were recorded. Results: There was no significant difference in the amount of estradiol increase and endometrial thickness measured on the day of IUI between the groups. At the time of ovulation induction, the number of follicles between 14-18 mm was 2 in the first group and 1 in the other two groups, but when the number of dominant follicles (>18 mm) was examined, there was no statistical difference between the groups. There were no statistical differences between groups in terms of pregnancy rates. Conclusion: In patients who underwent ovulation induction and IUI with CC and letrozole combined, CC alone and letrozole alone, no superiority was observed between the groups in terms of pregnancy rates.
REFERANSLAR
  1. Zegers-Hochschild F, Adamson GD, Dyer S, Racowsky C, de Mouzon J, Sokol R, et al. The International Glossary on Infertility and Fertility Care, 2017. Hum Reprod. 2017;32(9):1786-801. [Crossref]  [PubMed]  [PMC] 
  2. Sharp HT, Johnson JV, Lemieux LA, Currigan SM. Executive Summary of the reVITALize Initiative: Standardizing Gynecologic Data Definitions. Obstet Gynecol. 2017;129(4):603-7. [Crossref]  [PubMed] 
  3. Practice Committee of the American Society for Reproductive Medicine. Diagnostic evaluation of the infertile female: a committee opinion. Fertil Steril. 2015;103(6):e44-50. [Crossref] 
  4. Practice Committee of the American Society for Reproductive Medicine. Effectiveness and treatment for unexplained infertility. Fertil Steril. 2006;86(5 Suppl 1):S111-4. [Crossref]  [PubMed] 
  5. Zinaman MJ, Brown CC, Selevan SG, Clegg ED. Semen quality and human fertility: a prospective study with healthy couples. J Androl. 2000;21(1):145-53.
  6. Guzick DS, Sullivan MW, Adamson GD, Cedars MI, Falk RJ, Peterson EP, et al. Efficacy of treatment for unexplained infertility. Fertil Steril. 1998;70(2):207-13. [Crossref]  [PubMed] 
  7. Collins JA, Burrows EA, Wilan AR. The prognosis for live birth among untreated infertile couples. Fertil Steril. 1995;64(1):22-8. [Crossref]  [PubMed] 
  8. Farquhar CM, Liu E, Armstrong S, Arroll N, Lensen S, Brown J. Intrauterine insemination with ovarian stimulation versus expectant management for unexplained infertility (TUI): a pragmatic, open-label, randomised, controlled, two-centre trial. Lancet. 2018;391(10119):441-50. [Crossref]  [PubMed] 
  9. 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. [Crossref]  [PubMed]  [PMC] 
  10. 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(2):305-9. [Crossref]  [PubMed] 
  11. Al-Fozan H, Al-Khadouri M, Tan SL, Tulandi T. A randomized trial of letrozole versus clomiphene citrate in women undergoing superovulation. Fertil Steril. 2004;82(6):1561-3. [Crossref]  [PubMed] 
  12. Al-Omari WR, Sulaiman WR, Al-Hadithi N. Comparison of two aromatase inhibitors in women with clomiphene-resistant polycystic ovary syndrome. Int J Gynaecol Obstet. 2004;85(3):289-91. [Crossref]  [PubMed] 
  13. 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;286(6):1581-7. [Crossref]  [PubMed] 
  14. Huang S, Wang R, Li R, Wang H, Qiao J, Mol BWJ. Ovarian stimulation in infertile women treated with the use of intrauterine insemination: a cohort study from China. Fertil Steril. 2018;109(5):872-8. [Crossref]  [PubMed] 
  15. Diamond MP, Legro RS, Coutifaris C, Alvero R, Robinson RD, Casson P, et al. Letrozole, Gonadotropin, or Clomiphene for Unexplained Infertility. N Engl J Med. 2015;373(13):1230-40. [Crossref]  [PubMed]  [PMC] 
  16. Diamond MP, Legro RS, Coutifaris C, Alvero R, Robinson RD, Casson P, et al. Assessment of multiple intrauterine gestations from ovarian stimulation (AMIGOS) trial: baseline characteristics. Fertil Steril. 2015;103(4):962-73.e4. [Crossref]  [PubMed]  [PMC]