Comparison of clinical effects among clompiphene citrate,human menopausal gonadotropin and letrozole in ovulation induction in women with polycystic ovary syndrome

Objective To compare the clinical outcomes of clomiphene citrate(CC)+human menopausal gonadotropin(HMG),HMG,letrozole(LE)+HMG for ovulation induction among women with polycystic ovary syndrome(PCOS)undergoing intrauterine insemination(IUI)cycles with frozen donor sperm.Methods A total of 114 infertile women(114 cycles)with PCOS from December 2007 to May 2008 were randomly treated with CC+HMG(n=38),HMG(n=38)and LE+HMG(n=38).The number of follicles,serum T,serum estradiol,endometrial thickness,mono mature follicle rates per cycle,dose of HMG used per cycle and pregnancy rates per cycle were compared among the three groups.Results The mean age and T among groups were similar.The total number of mature follicles was significantly greater in the clomiphene citrate group than that in HMG group and LE+HMG group(2.9±1.6 vs.1.6±1.0 or 1.9±1.2,P0.05).Endometrial thickness at the time of HCG administration was significantly thinner in the CC+HMG group than the other two.No significant differences were found in the total number of mature follicles and endometrial thickness between HMG and LE+HMG cycles.No significant differences were found in serum estradiol among three groups.Significant differences were found in mono mature follicle rates per cycle among the three groups(21.05%,78.95% and 52.63%,P0.05).The dosage of HMG used per cycle among three groups was 4.89±1.59,9.88±4.59 and 9.68±4.67 ampules(75 IU/ampule).Significant differences were found between CC+HMG group and HMG group or LE+HMG group(P=0.00).No significant differences were found between HMG group and LE+HMG group.No significant differences were found in clinical pregnancy rates among three groups(36.84%,39.48% and 31.57%,P0.05).Conclusions Administration of HMG is helpful to obtain mono mature follicle in ovulation induction.The minimal dosage of HMG is required in combination of CC and HMG.Three different protocols come out with a comparable satisfactory pregnancy rate in IUI cycles.