Effect of estradiol valerate on endometrial thickness in polycystic ovary syndrome having ovulation induction with letrozole

Authors

  • Mahamuda Yasmin Department of Obstetrics and Gynecology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
  • Jesmin Banu Department of Reproductive Endocrinology and Infertility Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
  • Dilruba Akhter Department of Obstetrics and Gynecology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
  • Nighat Sultana Department of Obstetrics and Gynecology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
  • Sadia Afrin Munmun Department of Obstetrics and Gynecology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20232272

Keywords:

Endometrial thickness, Estradiol valerate, Letrozole

Abstract

Background: PCOS is a common endocrine disorder in women of reproductive age. Letrozole is an orally active aromatase inhibitor and as effective as chlomiphene citrate for induction of ovulation. Estrogen is important in the regeneration and growth of the endometrium prior to ovulation prepare the tissue to respond to progesterone post ovulation in PCOS patients. Aim of the study was to assess the effects of estradiol valerate on endometrial thickness in PCOS having ovulation induction with letrozole.

Methods: This randomized controlled study was conducted in the department of reproductive endocrinology and infertility, BSMMU, Dhaka, with 1 year duration. A total 80 diagnosed cases of PCOS patients with subfertility were included in this study. Among them 40 patients received letrozole and estradiol valerate and 40 patients received letrozole and placebo.

Results: On day 8, mean endometrial thickness was not statistically significant between two groups (p=0.436). On day of triggering, mean endometrial thickness was significantly higher in intervention group 9.2±1.4 mm than control group 8.2±1.4 mm (p=0.004). Mean changes of endometrial thickness on day of triggering compared with on day 8 was significantly higher in intervention group 3.2±1.5 mm than control group 2.5±1.6 mm (p=0.043). Pregnancy rate was higher in intervention group 13 (38.2%) than control group 8 (22.2%) with relative risk 1.72, 95% CI (0.82-3.63%), that was not statistically significant between two groups (p=0.144).

Conclusions: Mean changes of endometrial thickness on day of triggering were significantly higher in intervention group than control group. The pregnancy rate achieved with letrozole+estradiol valerate combination was higher than that achieved with letrozole and placebo group.

References

Joham AE, Teede HJ, Ranasinha S, Zoungas S, Boyle J. Prevalence of infertility and use of fertility treatment in women with polycystic ovary syndrome: data from a large community-based cohort study. J Women’s Health, 2015;24(4):299-307.

Escobar-Morreale HF. Polycystic ovary syndrome: definition, aetiology, diagnosis and treatment. Nat Rev Endocrinol. 2018;14(5):270-84.

Speroff L, Fritz MA, eds. Clinical gynecologic endocrinology and infertility. 7th edn. Lippincott Williams and Wilkins; 2005.

El-Gharib MN, Mahfouz AE, Farahat MA. Comparison of letrozole versus tamoxifen effects in clomiphene citrate resistant women with polycystic ovarian syndrome. J Reprod Infertile. 2015;16(1):30.

He D, Jiang F. Meta-analysis of letrozoleversusclomiphene citrate in polycystic ovary syndrome. Reprod biomed Online. 2011;23(1):91-6.

Mitwally MF, Casper RF. Use of an aromatase inhibitor for induction of ovulation in patients with an inadequate response to clomiphene citrate. Fertil Steril. 2001;75(2):305-9.

Çetinkaya K, Kadanalı S. The effect of administering vaginal estrogen to clomiphene citrate stimulated cycles on endometrial thickness and pregnancy rates in unexplained infertility. J Turk German Gynecol Assoc. 2012;13(3):157-61

Khanna SB, Kaul U. 2005. Effects of exogenous ethinyl estradiol on endometrial receptivity in clomiphene induced cycles in infertile women with polycystic ovaries. J K Sci. 2005;7(3):140-5.

Regal P, Vazquez BI, Franco CM, Cepeda A, Fente CA. Development of a rapid and confirmatory procedure to detect 17β-estradiol 3-benzoate treatments in bovine hair. J Agricult Food Chem. 2008;56(24):11607-11.

Seyedoshohadaei F, Tangestani L, Zandvakili F, Rashadmanesh N. Comparison of the effect of clomiphene-estradiol valerate versus letrozole on endometrial thickness, abortion and pregnancy rate in infertile women with polycystic ovarian syndrome. J Clin Diagn Res. 2016;10(8):QC10-Q13.

Alnemr AAA, Ammar IMM, Aboelfath AMK, Talaat B. Effect of estradiol valerate on the pregnancy rate in patients receiving letrozole for induction of ovulation. Middle East Fertil Soc J. 2017;23(2):131-6.

Wafa YA, Labib MM, Fatah AG. Role of letrozole versus clomiphene citrate in induction of ovulation in patients with polycystic ovarian syndrome. J Gynecol Reprod Med. 2017;1(1):1-6.

Mobusher I. Comparison of the efficacy of letrozole and clomiphene citrate for ovulation induction in infertile women with polycystic ovary syndrome. Age (years). 2014;24(2.33):24-9.

Satirapod C, Wingprawat S, Jultanmas R, Rattanasiri S, Jirawatnotai S, Choktanasiri W. Effect of estradiol valerate on endometrium thickness during clomiphene citrate‐stimulated ovulation. J Obstet Gynaecol Res. 2014;40(1):96-101.

Alhibshi LM, Sarhan AM, Abdo AM. Effect of letrozole versus clomiphene citrate plus estradiol valerate in patient with polycystic ovarian syndrome with inadequate response to clomiphene citrate. Zagazig Univ Med J. 2021;27(6):1524-32.

Giannaris D, Zourla A, Chrelias C, Loghis C, Kassanos D. Ultrasound assessment of endometrial thickness: correlation with ovarian stimulation and pregnancy rates in IVF cycles. Clin Exp Obstet Gynecol. 2008;35(3):190-3.

El-Toukhy T, Coomarasamy A, Khairy M, Sunkara K, Seed P, Khalaf Y, et al. The relationship between endometrial thickness and outcome of medicated frozen embryo replacement cycles. Fertil Steril. 2008;89(4):832-9.

Harira M. Use of Letrozole versus clomiphene-estradiol for treating infertile women with unexplained infertility not responding well to clomiphene alone, comparative study. Middle East Fertil Soc J. 2018;23(4):384-7.

Roy KK, Baruah J, Singla S, Sharma JB, Singh N, Jain SK, Goyal M. A prospective randomized trial comparing the efficacy of Letrozole and Clomiphene citrate in induction of ovulation in polycystic ovarian syndrome. J Hum Reprod Sci. 2012;5(1):20.

Begum MR, Ferdous J, Begum A, Quadir E. Comparison of efficacy of aromatase inhibitor and clomiphene citrate in induction of ovulation in polycystic ovarian syndrome. Fertil Steril. 2009;92(3):853-7.

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Published

2023-07-28

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Original Research Articles