Comparing of letrozole versus clomiphene citrate combined with gonadotropins in intrauterine insemination cycles

Background: Clomiphene citrate (CC) an agonist and antagonist of estrogen, is the first line treatment in ovarian stimulation. Anti-estrogenic effect of CC in endometrial thickness and cervical mucus has negative effect on pregnancy rate. Letrozole is an Aromatase Inhibitor has been seen that has acceptable pregnancy rate compared to CC. Objective: The aim of this study was to compare the efficacy of letrozole and clomiphene citrate (CC) with gonadotropins for ovarian stimulation in women candidate for intrauterine insemination (IUI). Materials and Methods: One hundred sixty patients eligible to IUI therapy enrolled in this study. Patients randomized to two groups: group A (received letrozole-gonadotropin) and group B (received CC-gonadotropin). In group A (n= 80) letrozole was given on days 3-7 of the menstrual cycles. In group B clomiphen citrate was given like letrozole combined with human menopausal gonadotropin (hMG) administered every day starting on day 8. Ovulation was triggered with urinary HCG when the leading follicle (s) reached 18 mm in diameter. A single IUI was performed 36-40 hours later. The ovarian stimulation response (E-2 levels and number of follicles, clinical pregnancy and endometrial thickness) was primary outcome. Results: Both groups were similar in demographic characteristics. There was a significantly lower peak serum E-2 level in the letrozole group compared with CC. (236 +/- 86 Vs. 283 +/- 106 pg/mL, respectively; p < 0.002). The number of mature (> 18 mm) preovulatory follicles was significantly higher in CC group than letrozole group (2.2 +/-.68 Vs. 2.02 +/- 0.63 respectively; p= 0.025). Endometrial thickness measured at the time of hCG administration was significantly higher in letrozole group. (9.08 +/- 1.2 mm Vs. 8.1 +/- 1.9 mm; p= 0.0001). The clinical pregnancy rate was comparable between two groups. Conclusion: Letrozole is a good and cost-effective alternative to CC in IUI cycles.