scholarly journals Effects of Letrozole in Prevention of Premature Luteinizing Hormone (LH) Surge in Infertile Women with Clomiphene Citrate Resistant Polycystic Ovary Syndrome (PCOS) Undergoing Intrauterine Insemination

2015 ◽  
Vol 4 (3) ◽  
pp. 104-11
Author(s):  
Afsoon Zarei ◽  
Tahere Bahrami Shabahrami ◽  
Nasrin Dadras
Keyword(s):  
Luteinizing Hormone ◽  
Pregnancy Rate ◽  
Polycystic Ovary ◽  
Endometrial Thickness ◽  
Intrauterine Insemination ◽  
Clomiphene Citrate ◽  
Control Group ◽  
Lh Surge ◽  
Significant Difference ◽  
Premature Lh Surge

Background: Polycystic ovarian syndrome (PCOS) is among the important causes of infertility in young women. Premature luteinizing hormone (LH) surge (PLS) is one of its complications. PLS can reduce the quality of oocytes and therefore decrease the success of intrauterine insemination (IUI). Letrozole, a non-steroidal aromatase inhibitor, prevents LH surge. In this study, we aim to evaluate the effects of letrozole on preventing premature LH surge in clomiphene-resistant patients with PCOS undergoing IUI. Materials and Methods: In this randomized clinical trial, 131 patients who were developed with PCOS were selected for IUI cycle, divided into two groups randomly: control group (n=67) and letrozole group (n=64). Incidence of premature LH surge, pregnancy, abortion and ongoing pregnancy rate, endometrial thickness and number of follicles were measured in both groups. Results: No significant difference was seen between mean ages in the two groups; 11.9% of the control group and 21.9% of the letrozole group became pregnant (P =0.005); furthermore, premature LH surge was seen in 4.7% of the letrozole group and 8.9% of the control group (P =0.003). E2 and Endometrial thickness was higher in letrozole group; however, LH was significantly higher in the control group (P =0.026). Conclusion: Administration of letrozole in clomiphene-resistant patients with PCO undergoing IUI cycle can decrease the incidence of PLS. In addition, it can increase pregnancy rate significantly. Therefore, using letrozole is more reasonable in patients who have not responded to clomiphene or are hypersensitive. [GMJ.2015;4(3):104-11]

scholarly journals Comparison of the efficiency of clomiphene citrate and letrozole in combination with metformin in moderately obese clomiphene citrate - resistant polycystic ovarian syndrome patients

2016 ◽  
Vol 144 (3-4) ◽  
pp. 146-150 ◽  
Author(s):  
Artur Bjelica ◽  
Aleksandra Trninic-Pjevic ◽  
Ljiljana Mladenovic-Segedi ◽  
Nenad Cetkovic ◽  
Djordje Petrovic
Keyword(s):  
Retrospective Study ◽  
Polycystic Ovary Syndrome ◽  
Pregnancy Rate ◽  
Polycystic Ovary ◽  
Intrauterine Insemination ◽  
Clomiphene Citrate ◽  
Obese Patients ◽  
Ovary Syndrome ◽  
Metformin Therapy ◽  
Significant Difference

Introduction. Polycystic ovary syndrome is the most common endocrinopathy in women of reproductiveage. Therapy for those who want to get pregnant involves ovulation induction using clomiphene citrate, metformin, letrozole and gonadotropins. Objective. The aim of the study was to compare the efficacy of combinations of clomiphene citrate-metformin and letrozole-metformin in obese patients who are resistant to clomiphene citrate alone. Methods. The investigation was conducted as a retrospective study involving 60 moderately obese patients with polycystic ovary syndrome. Thirty-one of them received the clomiphene citrate-metformin, and 29 letrozole-metformin therapy. Stimulation was carried out for the procedures of intrauterine insemination (IUI). Results. The age of patients, duration of infertility, and body mass index in both groups were similar. There was statistically significant difference in the thickness of the endometrium in favor of the group having the letrozole-metformin therapy (8.9 ? 1.7 mm) compared with the group receiving the clomiphene citrate-metformin treatment (6.3 ? 1.3 mm). The number of follicles was not statistically significantly different. Pregnancy rate in the first cycle of IUI in the clomiphene citrate group was 6.4%, and 17.2% in the letrozole group, which also was not statistically different. After the third IUI cycle, the pregnancy rate was significantly higher in the letrozole group (20.6%), while in the clomiphene citrate group it was (9.6%). Conclusion. This retrospective study demonstrated the advantages of the use of letrozole over clomiphene citrate in combination with metformin in moderately obese patients with polycystic ovary syndrome who are resistant to stimulation with clomiphene citrate alone.

scholarly journals Endometrial and follicular development following stair-step and traditional protocols in women with polycystic ovary syndrome: An RCT

2021 ◽  
Author(s):  
Sholeh Shahgheibi ◽  
Fariba Seyedoshohadaei ◽  
Danial Khezri ◽  
Solmaz Ghasemi
Keyword(s):  
Polycystic Ovary Syndrome ◽  
Polycystic Ovary ◽  
Endometrial Thickness ◽  
Clomiphene Citrate ◽  
Ovarian Follicles ◽  
Left Ovary ◽  
Ovulation Rate ◽  
Control Group ◽  
Ovary Syndrome ◽  
Significant Difference

Background: Various strategies have been proposed for polycystic ovary syndrome (PCOS) treatment. Objective: To investigate and compare the number and size of ovarian follicles, endometrial thickness, and ovulation rate by traditional protocol (TP) and stair-step protocol (SSP). Materials and Methods: Sixty infertile PCOS women were allocated into two groups (SSP = 30 and control TP = 30) between May and October 2019 in the Besat Hospital, Sanandaj, Iran. In the SSP group, the infertile women were treated with 50 mg/daily clomiphene citrate (CC) for five days, while the nonresponsive women were prescribed 100 mg daily CC for five days in the same cycle. The maximum dose (150 mg) was administered until ovulation occurred. In the control group, in non-ovulatory cases, the dose was increased in the next cycle. Ultrasound was used to detect ovulation. Results: Endometrial thickness changes with various doses of CC were significantly different in the TP. The comparison of both protocols showed a significant difference in endometrial thickness only at 50 mg CC. The number of follicles in the left ovary was significantly different in both protocols at 150-mg CC. The size of ovarian follicles in the left ovary was significantly different between the two protocols at 100-mg CC. The ovulation rate was significantly different in the SSP at 100- and 150-mg doses of CC. Moreover, 86% of ovulation occurred at 100-mg CC in the SSP, while this rate was 73% in the TP. Conclusion: The most appropriate dose for ovulation in patients with PCOS is 100 mg CC. Key words: Polycystic ovary syndrome, Clomiphene, Infertility, Ovulation induction.

scholarly journals Role of intrauterine tubo-peritoneal insemination and intrauterine insemination in the treatment of infertility

2017 ◽  
Vol 5 (5) ◽  
pp. 2057
Author(s):  
Disha Gupta ◽  
Asha Verma ◽  
Richa Gupta ◽  
Soniya Saini ◽  
Anuradha Salvi ◽  
...  
Keyword(s):  
Pregnancy Rate ◽  
Endometrial Thickness ◽  
Intrauterine Insemination ◽  
Clomiphene Citrate ◽  
Positive Outcome ◽  
Exclusion Criteria ◽  
Significant Difference ◽  
Infertile Patients ◽  
Urine Pregnancy Test

Background: Infertility management has become more substantial and relevant with an increase in the number of infertile patients as well as advances in the science of reproduction. The objective of our study was to assess the role of intrauterine tuboperitoneal insemination (IUTPI) and intrauterine insemination (IUI) in the treatment of infertile patients.Methods: 236 infertile patients, 118 in each group attending the infertility clinic, after applying both inclusion and exclusion criteria were enrolled in the present study. Patients in each study group were given clomiphene citrate for ovarian stimulation followed by injection hCG for triggering ovulation. Insemination with washed husband’s sperm was performed about 36-40 hours after hCG administration, using 10ml of  inseminate in IUTPI and 0.5ml inseminate in IUI. The patient was then called after 2 weeks for urine pregnancy test (UPT) which, if positive was considered as clinical pregnancy.Results: Out of the total 236 cases, 42 cases had a positive outcome. Out of these 42 positive cases, 27 were from IUTPI group whereas 15 from IUI group. The pregnancy rate was 22.88% in IUTPI and 12.71% in IUI (p=0.039), which was a statistically significant difference. Endometrial thickness, preovulatory follicle number and prewash sperm motility significantly affected positive outcome in IUTPI. Factors like patient’s age, BMI<25, bilateral patent tubes and decreased duration of infertility also positively affected the treatment outcome.Conclusions: Our study found IUTPI to have better pregnancy rate compared to IUI. IUTPI may become a first line option for treatment of infertile patients.

scholarly journals Letrozole versus Clomiphene Citrate for Induction of Ovulation in Patients with Polycystic Ovarian Syndrome Undergoing Intrauterine Insemination

2011 ◽  
Vol 5 ◽  
pp. CMRH.S6598 ◽  
Author(s):  
Sherif F. Hendawy ◽  
Hanan E. Samaha ◽  
Mohamed F. Elkholy
Keyword(s):  
Polycystic Ovary ◽  
Endometrial Thickness ◽  
Intrauterine Insemination ◽  
Transvaginal Ultrasound ◽  
Clomiphene Citrate ◽  
Randomized Study ◽  
Multiple Pregnancy ◽  
Reproductive Age ◽  
Induction Of Ovulation ◽  
Significant Difference

Background Polycystic ovary syndrome (PCOS) is one of the most common endocrinopathies affecting women in the reproductive age group, and is one of the most common causes of hyperandrogenic anovulatory infertility. The aromatase inhibitor, letrozole, has been used for induction of ovulation. The purpose of this study was to compare the effects of letrozole and clomiphene citrate in induction of ovulation among patients with PCOS undergoing intrauterine insemination. Methods In a double-blind randomized study, 60 infertile patients with PCOS received standard doses of either clomiphene citrate or letrozole as an induction protocol prior to intrauterine insemination. A hormonal profile, pelvic ultrasound, hysterosalpingogram, and/ or laparoscopy were done for all patients. The patients were monitored for ovulation by translational ultrasonographic folliculometry, with measurement of number and size of the follicles, as well as endometrial thickness. Human chorionic gonadotrophin (HCG) was injected intramuscularly when at least one mature follicle > 18 mm diameter was detected, and intrauterine insemination was performed 32-36 hours later. Transvaginal ultrasound and β-HCG measurement were performed for confirmation of pregnancy. Results Letrozole and clomiphene citrate achieved follicle maturation within a mean ± standard deviation (SD) of 13.2 ± 1.53 and 14.1 ± 1.35 days, respectively, showing no significant difference (P > 0.05). The mean number of follicles reaching >18 mm on the day of HCG administration was significantly higher in patients who received clomiphene citrate (2.9 ± 1.77) than in those receiving letrozole (1.2 ± 0.9). Letrozole had a significantly greater effect than clomiphene citrate on endometrial thickness (9.16 ± 1.36 versus 4.46 ± 1.71). The number of pregnancies achieved in the letrozole group was significantly (P < 0.05) greater than in the clomiphene group. Conclusion Letrozole in patients with PCOS is as effective as clomiphene citrate in inducing ovulation, and although the number of follicles produced by induction with letrozole were less than those produced by clomiphene, letrozole had a significantly greater effect on endometrial thickness than clomiphene citrate, and the incidence of pregnancy after intrauterine insemination was significantly higher, with a lower incidence of multiple pregnancy.

scholarly journals Letrozole Versus Clomiphene Citrate for Superovulation in Intrauterine Insemination Cycles - Retrospective Comparative Study Conducted in the Department of Reproductive Medicine, Mahatma Gandhi Medical College & Hospital, Jaipur

2021 ◽  
Vol 10 (27) ◽  
pp. 1991-1995
Author(s):  
Jawahira Chishti ◽  
Jai Chowdhary ◽  
Archana Paliwal ◽  
Chetan Kumar Sharma ◽  
Manisha Choudhary
Keyword(s):  
Pregnancy Rate ◽  
Ovulation Induction ◽  
Endometrial Thickness ◽  
Intrauterine Insemination ◽  
Clomiphene Citrate ◽  
Peripheral Tissues ◽  
Sperm Density ◽  
Estrogen Production ◽  
Oral Agents ◽  
Significant Difference

BACKGROUND Superovulation with intrauterine insemination (IUI) increases the probability of pregnancy by increasing number of oocytes and sperm density. The main oral agents used for superovulation are clomiphene citrate and letrozole. Clomiphene citrate a selective estrogen receptor modulator with predominant antiestrogenic action has adverse effects on endometrium and cervical mucous. Letrozole an aromatase inhibitor acts by reducing estrogen production by blocking androgen conversion to estrogen in ovary and peripheral tissues without affecting endometrium and cervical mucous. We wanted to compare the efficacy of letrozole v/s clomiphene citrate as first line ovulation induction drug in infertile patients undergoing IUI. METHODS Based on the inclusion and exclusion criteria, we included 160 patients in our study. They were divided into two groups of 80 each based on the drug given for ovulation induction. The drug was given for 5 days from D3 to D7 of menstrual cycle. IUI was done 38 - 40 hours after trigger and after confirmation of ovulation by sonography. RESULTS The mean age, body mass index (BMI), duration of infertility, type and cause of infertility in both groups were similar. Ovulation rate was 85 % in letrozole group and 71.25 % in clomiphene citrate group, which was statistically significant (P0.035). There was no statistically significant difference between endometrial thickness and total days till ovulation between two groups. Monofolliculogenesis and clinical pregnancy rate were statistically significantly higher in letrozole group. CONCLUSIONS Our study shows that letrozole has better pregnancy rate in comparison to clomiphene citrate (C. C.) in IUI cycles with less risk of anovulation, thin endometrium and multi follicular growth. KEY WORDS Clomiphene Citrate (C.C.), Letrozole (LTZ), Ovulation Induction (OI), Intrauterine Insemination (IUI)

scholarly journals The effects of adding Gonadotropin-releasing Hormone antagonist on cycle characteristics and pregnancy rate in stimulated Intrauterine Insemination (IUI) cycle

2020 ◽  
Vol 11 (3) ◽  
pp. 3053-3060
Author(s):  
Rawaa saad Hassan Abunaila ◽  
Lubna Amer Al-anbari ◽  
Muayad Sraibet Abbood
Keyword(s):  
Pregnancy Rate ◽  
Assisted Reproductive Technologies ◽  
Intrauterine Insemination ◽  
Clomiphene Citrate ◽  
Study Groups ◽  
Reproductive Technologies ◽  
Control Group ◽  
Human Menopausal Gonadotropin ◽  
Study Group ◽  
Significant Difference

A prospective randomised (comparative) study was conducted in the High Institute for Infertility Diagnosis and Assisted Reproductive Technologies in AL-Nahrain University, Baghdad – Iraq, from the 1st of October 2018 till 1st of September 2019 involving seventy women of infertile couples with the same inclusion and exclusion criteria. They were randomly allocated into two groupsreceiving minimal ovarian stimulation protocol (Clomiphene Citrate and Human Menopausal Gonadotropin) with IUI adding flexible GnRH antagonist protocol (Cetrorelix) to the study group. IUI was done 40-44 hours after ovulation trigger. There were no significant statistical variances among control and study groups in demographic characteristics concerning: age, BMI, type, duration and cause of infertility. There was no important variance in a mean day of trigger among control and study groups, 12.43 ±1.56 versus 13.11 ±1.49, at the same order (p = 0.064). The Mean number of dominant follicles was considerably greater in study groups than that of the group control, 2.40±1.03 versus 1.89±0.83, respectively (p = 0.025).Mean serum Estradiol of the study group was significantly higher than that of the control group, 478.68 ±423.61 versus 273.12 ±254.57, respectively (p = 0.016). The proportion of women with LH> 10 were significantly less frequent in the study group in comparison with the control group, 22.9 % versus 68.6 %, at the same order (p < 0.001). There was no important variance in mean serum Progesterone among control and study groups. There was no significant difference in the characteristic of the dominant follicle, ruptured versus not ruptured, (p = 0.124) on the day of IUI. The pregnancy rate was higher in the study group when compared with the control group; however, the difference in pregnancy rate doesn’t reach statistical import (p = 0.145)

scholarly journals Association between Luteinizing Hormone/Choriogonadotropin Receptor Ins18LQ Gene Polymorphism and Polycystic Ovary Syndrome

2020 ◽  
Vol 8 (A) ◽  
pp. 517-520
Author(s):  
Hilma Putri Lubis ◽  
Muhammad Fidel Ganis Siregar ◽  
Ichwanul Adenin ◽  
Binarwan Halim ◽  
Henry Salim Siregar ◽  
...  
Keyword(s):  
Luteinizing Hormone ◽  
Polycystic Ovary Syndrome ◽  
Gene Polymorphism ◽  
Polycystic Ovary ◽  
Control Group ◽  
Control Groups ◽  
Ovary Syndrome ◽  
Significant Difference ◽  
Pcos Group ◽  
And Control

BACKGROUND: Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders of women in the childbearing period. However, its pathophysiology is still unclear. Certain polymorphisms of the luteinizing hormone/choriogonadotropin receptor (LHCGR) genes may lead to changes in the bioactivity of this hormone. The important functional role of LHCGR in the metabolism of androgen and ovulation, the LHCGR gene variant, may be related to the risk of PCOS. AIM: The aim of this study was to evaluate the association between LHCGR Ins18LQ gene polymorphism and PCOS. METHODS: A case–control study was performed in women with PCOS and non-PCOS from May 2019 to October 2019 in HFC IVF Center. We included 50 women with PCOS and 50 healthy controls. Polymorphism of the LHCGR (ins18LQ) gene was genotyped using polymerase chain reaction-restriction fragment length polymorphism. RESULTS: From this study, we found that there was no significant difference in the proportion of ages between the groups (p > 0.05). There were significant differences in the characteristics of body mass index, FSH level, LH level, and LH/FSH ratio between the PCOS and control groups (p < 0.05). We also found that the proportion of heterozygote variant non-ins/ins was higher in the PCOS group compared to the control group, but there was no significant difference between the polymorphisms of the non-ins and non-nonins variants between the PCOS and control groups (p = 0.269). The frequency of ins alleles was higher in the PCOS group compared to the control group. CONCLUSION: There was no significant association between LHCGR ins18LQ gene polymorphism and PCOS.

scholarly journals A study for evaluation of two protocols comprising of clomiphene citrate, human menopausal gonadotropin with or without follicle stimulating hormone for ovulation induction in patients with infertility for intrauterine insemination

2019 ◽  
Vol 8 (6) ◽  
pp. 2487
Author(s):  
Ashok Verma ◽  
Shivani Sharma ◽  
Suresh Verma ◽  
Pankaj Sharma ◽  
Tenzin Tsamo Tenga ◽  
...  
Keyword(s):  
Menstrual Cycle ◽  
Pregnancy Rate ◽  
Ovulation Induction ◽  
Endometrial Thickness ◽  
Intrauterine Insemination ◽  
Clomiphene Citrate ◽  
Human Menopausal Gonadotropin ◽  
Multiple Gestation ◽  
Group A ◽  
Group B

Background: To compare two protocols comprising of FSH/CC/HMG and CC/HMG for ovulation induction and IUI in women with infertility.Methods: 60 women with unexplained infertility were randomized using sequentially numbered opaque envelope method. Group A received inj FSH 150 units on day 2 of menstrual cycle and clomiphene citrate 100 mg from day 3-7, followed by injection HMG 150 units on day 9 of menstrual cycle. Group B received clomiphene citrate 100 mg from day 3-7, and HMG 150 units on day 7 and 9 of the menstrual cycle.  Ovulation triggered with hCG 5000 units when dominant follicle was 18mm. Single IUI was done 36-42 hours afterwards.Results: Pregnancy occurred in 3 out of 30 women in 116 cycles Group A (with FSH) with a pregnancy rate of 10 percent, and 2.8% per cycle. In group B (without FSH) pregnancy occurred in 3 out of 30 women in 117 cycles with pregnancy rate of 10 percent, and 2.6% per cycle. The number of follicles per cycle was 1.36 and follicle size was 18.57 mm in group A. While in Group B numbers of follicles per cycle were 1.22, with average size of 18.9mm. Mean endometrial thickness was 7.7mm in Group A and 6.37 in Group B (p=.01, significant). Mild OHSS was observed in one woman in Group B. No other side effects were observed in both the groups.Conclusions: The controlled ovarian stimulation regimes used in this study are equally effective, easy to administer, require less intensive monitoring and fewer medications, with little risk of OHSS and multiple gestation.

Clomiphene Citrate or Letrozole for Ovulation Induction in Women with Polycystic Ovarian Syndrome: A Prospective Randomized Trial

2010 ◽  
Vol 2 (2) ◽  
pp. 169-173
Author(s):  
Randhir Puri ◽  
Ahmed Badawy ◽  
Ibrahim Abdel Aal ◽  
Mohamed Abulatta
Keyword(s):  
Randomized Trial ◽  
Ovulation Induction ◽  
Polycystic Ovary ◽  
Endometrial Thickness ◽  
Clomiphene Citrate ◽  
University Teaching ◽  
Prospective Randomized Trial ◽  
Serum Estradiol ◽  
Serum Progesterone ◽  
Significant Difference

Objective To compare the effects of letrozole (5 mg) and clomiphene citrate (100 mg) for ovulation induction in women with polycystic ovary syndrome (PCOS). Design Prospective randomized trial. Setting University teaching hospital and private practice setting. Patients The study comprised a total of 438 infertile women (1063 cycles) with PCOS. Intervention Patients were randomized to treatment with 5 mg of letrozole daily (218 patients, 545 cycles) or 100 mg of clomiphene citrate daily (220 patients, 518 cycles) for 5 days starting on day 3 of menses. Timed intercourse was advised 24 to 36 hours after hCG injection. Main Outcome Measure Number of follicles, serum estradiol, serum progesterone, endometrial thickness, and pregnancy and miscarriage rates. Results The mean age, parity, and duration of infertility in both groups were similar. The total number of follicles was statistically significantly greater in the clomiphene citrate group (6.8 _ 0.3 vs 4.4 _ 0.4). Endometrial thickness at the time of hCG administration was statistically significantly greater in the CC group (9.2 _ 0.7 mm vs 8.1 _ 0.2 mm). The duration to reach a dominant follicle was statistically significantly longer in the letrozole group (12.1_1.3 vs 8.8_2.9 days). Ovulation occurred in 365 out of 540 cycles (67.5%) in letrozole group and 371 out of 523 cycles (70.9%) without a statistically significant difference. Levels of serum estradiol and progesterone were statistically significantly higher in the clomiphene citrate group. The pregnancy rate per cycle was 15.1% in the letrozole group and 17.9% in the clomiphene citrate group without statistically difference between the groups. Conclusion The results of this study did not show any advantage to the use of letrozole over clomiphene citrate as a first-line treatment for induction of ovulation in women with PCOS (Fertil Steril_2009;92:849-52. _2009 by American Society for Reproductive Medicine).

scholarly journals Effects of Letrozole-HMG and Clomiphene-HMG on Incidence of Luteinized Unruptured Follicle Syndrome in Infertile Women Undergoing Induction Ovulation and Intrauterine Insemination: A Randomised Trial

2015 ◽  
Vol 8 (4) ◽  
pp. 244 ◽  
Author(s):  
Azra Azmoodeh ◽  
Mansoureh Pejman Manesh ◽  
Firouzeh Akbari Asbagh ◽  
Azizeh Ghaseminejad ◽  
Zeinab Hamzehgardeshi
Keyword(s):  
Menstrual Cycle ◽  
Endometrial Thickness ◽  
Intrauterine Insemination ◽  
Clomiphene Citrate ◽  
Randomised Trial ◽  
Induction Of Ovulation ◽  
Infertile Women ◽  
Significant Difference ◽  
Preovulatory Follicles ◽  
Luteinized Unruptured Follicle

<p><strong>BACKGROUND: </strong>Luteinized unruptured follicle (LUF) syndrome is considered a cause of ovulation failure and a subtle cause of infertility. Preovulatory injection of human chorionic gonadotropin (HCG) prevents or treats LUF syndrome, but it has also occurred after the induction of ovulation with clomiphene/HMG and HCG. This study was designed for evaluation and comparison of LUF incidence in eligible infertile women undergoing two stimulation protocols (clomiphene + HMG<strong> </strong>and letrozole + HMG) in addition to intrauterine insemination (IUI). Some related factors were compared between LUF and non-LUF cycles as secondary outcomes.</p> <p><strong>METHODS:</strong> The study was designed as a prospective randomized controlled trial. Patients were randomized using a table of random numbers into two equal protocol groups.<strong> </strong>For group A, (n = 90) clomiphene citrate was administrated orally in doses of 100 mg/day, and group B (n = 90) orally received letrozole 5 mg/day from day 3 to 7 of the menstrual cycle. Then HMG 75IU/day was administered intramuscularly in both groups on day 8 of the menstrual cycle and the dose was adjusted on the basis of ovarian response. The optimum size of preovulatory follicles for the injection of HCG (10,000 IU) was considered 18–23 mm. The number and size of preovulatory follicles were assessed by vaginal ultrasound 12 h before HCG (D0). Endometrial thickness was measured as well. IUI was performed on all patients 38–40 h after HCG. The second ultrasound examination was performed to observe the evidence of oocyte releasing at the time of IUI (D1). If the follicles were unruptured,<strong> </strong>a<strong> </strong>third sonography was performed on day 7 after HCG (D7) to observe LUF syndrome.</p> <p><strong>RESULTS: </strong>There was a significant difference between clomiphene-HMG and letrozole-HMG in LUF (p = 0.021) and pregnancy (p = 0.041). The complete LUF in letrozole-HMG was lower than the alternative group and the pregnancy rate was higher. The patients in the non-LUF group had higher midluteal progesterone and a thicker endometrium compared to LUF cycles (p = 0.039) and (p &lt; 0.001). The results of our multivariate logistic regression indicate that size 18–19.9 mm leads to the complete LUF  less than ≥22 mm [AOR: 0.25, P = 0.005], and  in size 20– 21.9 mm  as well [AOR: 0.17, P = 0.002].</p> <p><strong>CONCLUSION: </strong>Letrozole, with lower incidences of LUF, is more effective than clomiphene citrate for the induction of ovulation in IUI cycles. In our study, we illustrated that larger follicles of ≥22 mm diameter were associated with higher incidences of LUF. We recommend that further studies investigate and focus on the relationship between follicular size and/or full hormonal profiles and LUF.<strong></strong></p>

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