Comparison of letrozole and clomiphene citrate efficacy along with gonadotrophins in controlled ovarian hyperstimulation for intrauterine insemination cycles

We performed this study to investigate and compare the effects of Letrozole and gonadotrophins versus Clomiphene Citrate and gonadotrophins in women undergoing superovulation for Intrauterine Insemination [IUI]. We performed this prospective cohort study at Australian Concept and Fertility centre, Karachi Pakistan. Women younger than 40 years of age with patent fallopian tubes and infertility of more than 2 years in duration who were undergoing IUI and gonadotrophins therapy were divided into two groups, one received Letrozole for 5 days and another received Clomiphene Citrate for 5 days. All 500 IUI treatment cycles conducted from March 2008 to March 2010 were included. Patients co-treated with Letrozole required fewer gonadotrophins administrations [median difference, 300 IU [95% confidence interval [CI], 225-375 IU], developed more follicles larger than 14 mm [median difference, 1 follicle, 95% CI, 1-2 follicles], and had a thicker endometrium [median difference, 1 mm, 95% CI, 0.4-1.6 mm]. The pregnancy rate was not significantly different between two groups [11% vs. 12.6%]. The addition of Letrozole to gonadotrophins decreases gonadotrophins requirements and improves endometrial thickness, without a significant effect on pregnancy rates. An improved pregnancy rate has been observed in older age group, >35 years with Letrozole

Intracytoplasmic sperm injection outcome using ejaculated sperm and retrieved sperm in azoospermic men

We aimed to determine pregnancy and miscarriage rates following intracytoplasmic sperm injection [ICSI] cycles using retrieved epididymal and testicular sperm in azoospermic men and ejaculated sperm in oliogospermic and normospermic men. This retrospective study was carried out on 517 couples who underwent ICSI. They included 96 couples with azoospermia and 421 with oligospermia or normal sperm count in the male partner. Of the men with azoospermia, 69 underwent percutaneous epididymal aspiration [PESA] and 47 underwent testicular sperm extraction [TESE]. In the 421 men with oligospermia or normal sperm count, ejaculated sperm was used for ICSI. The differences in the outcomes of ICSI using PESA or TESE and ejaculated sperm were evaluated. The main outcome measures were pregnancy and miscarriage rates. No significant differences were seen in pregnancy and miscarriage rates with surgically retrieved and ejaculated sperm. The pregnancy rates [including frozen embryo transfer] were 43.5%, 36.2%, and 41.4% in couples with PESA, TESE, and ejaculated sperm, respectively [P=.93]. The miscarriage rates were 16.7%, 23.5%, and 12.1, respectively [P=.37]. Intracytoplasmic sperm injection in combination with PESA and TESE is an effective method and can successfully be performed to treat men with azoospermia. The outcomes with these procedures are comparable to ICSI using ejaculated sperm