Barman Tithi, Singh Vinita, Bagde Nilajkumar D
Obstetrics and Gynaecology, All India Institute of Medical Sciences, Raipur, IND.
Cureus. 2025 Jul 26;17(7):e88802. doi: 10.7759/cureus.88802. eCollection 2025 Jul.
Background Millions of people of reproductive age worldwide struggle with infertility. Treatments such as controlled ovarian hyperstimulation and intrauterine insemination (IUI) are commonly used to address various causes of infertility. Medications such as clomiphene citrate (CC) and letrozole, when combined with human menopausal gonadotropin (HMG), have been shown to improve pregnancy rates and reduce treatment costs. Objective This study aimed to compare the effect of minimal stimulation using HMG with either CC or letrozole for ovulation induction in women with CC-resistant anovulatory infertility. It also assessed the impact of these combinations on follicular development and endometrial thickness. Materials and methods This retrospective cohort study included data from 84 infertile women diagnosed with polycystic ovary syndrome (PCOS). Participant records were retrieved from the hospital database at AIIMS, Raipur, India, covering the period from April 2021 to August 2022. Women were divided into two groups based on their treatment: one group received CC 100 mg and the other letrozole 5 mg, both in combination with HMG administered on alternate days. Forty-two women received letrozole + HMG and 40 received CC + HMG. Two participants in the CC group were excluded due to the development of four dominant follicles. Transvaginal ultrasound was performed on alternate days until follicles exceeded 17 mm. IUI was carried out 36 hours after HCG administration. Fourteen days later, a urinary pregnancy test was done if the participant had not yet menstruated. The clinical pregnancy rates were compared between the two groups. Results There was no significant difference between the two groups in terms of mean follicular diameter, number of dominant follicles, endometrial thickness, HMG dosage required, or the number of days to achieve dominant follicle formation. The IUI outcomes were also comparable in both groups. Conclusion The study concludes that both letrozole and CC, when combined with HMGs, are equally effective in inducing ovulation and achieving successful IUI outcomes in women with CC-resistant anovulatory infertility.
全球数百万育龄人口面临不孕问题。控制性卵巢过度刺激和宫腔内人工授精（IUI）等治疗方法常用于解决各种不孕原因。枸橼酸氯米芬（CC）和来曲唑等药物与人类绝经期促性腺激素（HMG）联合使用时，已显示可提高妊娠率并降低治疗成本。目的：本研究旨在比较使用HMG进行最小刺激联合CC或来曲唑对CC抵抗性无排卵性不孕女性进行促排卵的效果。它还评估了这些联合用药对卵泡发育和子宫内膜厚度的影响。材料和方法：这项回顾性队列研究纳入了84名被诊断为多囊卵巢综合征（PCOS）的不孕女性的数据。参与者记录从印度赖布尔全印医学科学研究所（AIIMS）的医院数据库中检索，涵盖2021年4月至2022年8月期间。根据治疗方法将女性分为两组：一组接受100mg CC，另一组接受5mg来曲唑，两者均与隔天给药的HMG联合使用。42名女性接受来曲唑+HMG，40名接受CC+HMG。CC组有两名参与者因出现四个优势卵泡而被排除。隔天进行经阴道超声检查，直到卵泡超过17mm。在注射HCG后36小时进行IUI。14天后，如果参与者尚未月经，则进行尿妊娠试验。比较两组的临床妊娠率。结果：两组在平均卵泡直径、优势卵泡数量、子宫内膜厚度、所需HMG剂量或达到优势卵泡形成的天数方面没有显著差异。两组的IUI结果也具有可比性。结论：该研究得出结论，来曲唑和CC与HMG联合使用时，在诱导CC抵抗性无排卵性不孕女性排卵和实现成功的IUI结果方面同样有效。
