Clomiphene citrate versus letrozole with gonadotropins in intrauterine insemination cycle

Authors

  • Nikita Jindal Department of Obstetrics and Gynecology, Lala Lajpat Rai Memorial Medical College, Meerut, Uttar Pradesh, India
  • Shakun Singh Department of Obstetrics and Gynecology, Lala Lajpat Rai Memorial Medical College, Meerut, Uttar Pradesh, India
  • Rachna Chaudhary Department of Obstetrics and Gynecology, Lala Lajpat Rai Memorial Medical College, Meerut, Uttar Pradesh, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20260191

Keywords:

Clomiphene citrate, Gonadotropins, Infertility, Letrozole

Abstract

Background: This study aimed to evaluate and compare the efficacy of clomiphene citrate (CC) and letrozole, both alone and in combination with gonadotropins, for ovulation induction in infertile women.

Methods: A total of 200 participants were divided into four groups: CC alone, letrozole alone, CC plus gonadotropins, and letrozole plus gonadotropins. Ovulation was monitored via transvaginal ultrasonography, with human chorionic gonadotropin (HCG) administered to trigger ovulation when follicles reached ≥18 mm. Intrauterine insemination (IUI) was performed 24-36 hours post-HCG administration.

Results: The letrozole plus gonadotropins group exhibited the highest ovulation rate (86%), followed by CC plus gonadotropins (84%), letrozole alone (72%), and CC alone (70%). Endometrial thickness was significantly greater in the letrozole group (8.53±1.40 mm) compared to the CC group (7.47±0.89 mm; p=0.000), and the size of the dominant follicle was also larger with letrozole (19.20±4.87 mm) than with CC (17.54±5.44 mm; p=0.02).

Conclusions: Letrozole, particularly when combined with gonadotropins, may be more effective than CC in inducing ovulation and enhancing endometrial receptivity, thereby potentially improving pregnancy outcomes in infertile women.

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References

Dankert T, Kremer JA, Cohlen BJ, Hamilton CJ, Pasker-de Jong PC, Straatman H, et al. A randomized clinical trial of clomiphene citrate versus low dose recombinant FSH for ovarian hyperstimulation in intrauterine insemination cycles for unexplained and male subfertility. Hum Reprod. 2007;22:792-7. DOI: https://doi.org/10.1093/humrep/del441

Huang S, Wang R, Li R, Wang H, Qiao J, Mol BWJ. Ovarian stimulation in infertile women treated with the use of intrauterine insemination: a cohort study from China. Fertil Steril. 2018;109:872-8. DOI: https://doi.org/10.1016/j.fertnstert.2018.01.008

Wild RA. Clinical utility of ovarian-stimulation intrauterine insemination. Fertil Steril. 2018;109:795-6. DOI: https://doi.org/10.1016/j.fertnstert.2018.01.021

Gunn DD, Bates GW. Evidence-based approach to unexplained infertility: a systematic review. Fertil Steril. 2016;105:1566-74. DOI: https://doi.org/10.1016/j.fertnstert.2016.02.001

Beck J, Boothroyd C, Proctor M, Farquhar C, Hughes E. Oral anti-oestrogens and medical adjuncts for subfertility associated with anovulation. Cochrane Database Syst Rev. 2005;2005:CD002249. DOI: https://doi.org/10.1002/14651858.CD002249.pub2

Eskew AM, Bedrick BS, Hardi A, Stoll CRT, Colditz GA, Tuuli MG, et al. Letrozole compared with clomiphene citrate for unexplained infertility: a systematic review and meta-analysis. Obstet Gynecol. 2019;133:437-44. DOI: https://doi.org/10.1097/AOG.0000000000003105

Sachdeva G, Gainder S, Suri V, Sachdeva N, Chopra S. Prediction of responsiveness to clomiphene citrate in infertile women with PCOS. J Reprod Infertil. 2019;20:143-50.

Hobeika E, Malik S, Traub ML, Demissie S, Knochenhauer ES. Use of concomitant FSH with hCG at the time of trigger may improve success rates of couples with poor ovarian response undergoing gonadotropin therapy with IUI. J Reprod Med. 2017;62:229-33.

Liu Y, Ye XY, Chan C. The association between endometrial thickness and pregnancy outcome in gonadotropin-stimulated intrauterine insemination cycles. Reprod Biol Endocrinol. 2019;17:14. DOI: https://doi.org/10.1186/s12958-019-0455-1

Weiss NS, Kostova E, Nahuis M, Mol BWJ, van der Veen F, van Wely M. Gonadotropins for ovulation induction in women with polycystic ovary syndrome. Cochrane Database Syst Rev. 2019;1:CD010290. DOI: https://doi.org/10.1002/14651858.CD010290.pub3

Kar S. Current evidence supporting “letrozole” for ovulation induction. J Hum Reprod Sci. 2013;6:93-8. DOI: https://doi.org/10.4103/0974-1208.117166

Amer SA, Smith J, Mahran A, Fox P, Fakis A. Double-blind randomized controlled trial of letrozole versus clomiphene citrate in subfertile women with polycystic ovarian syndrome. Hum Reprod. 2017;32:1631-8. DOI: https://doi.org/10.1093/humrep/dex227

Ilangovan S. A comparative study of letrozole and clomiphene citrate for ovulation induction in women with polycystic ovarian syndrome: a randomized controlled trial. Int J Reprod Contracept Obstet Gynecol. 202413(8):1999-2003. DOI: https://doi.org/10.18203/2320-1770.ijrcog20241954

Bansal S, Goyal M, Sharma C, Shekhar S. Letrozole versus clomiphene citrate for ovulation induction in anovulatory women with polycystic ovarian syndrome: a randomized controlled trial. Int J Gynaecol Obstet. 2021;152(3):345-50. DOI: https://doi.org/10.1002/ijgo.13375

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Published

2026-01-29

How to Cite

Jindal, N., Singh, S., & Chaudhary, R. (2026). Clomiphene citrate versus letrozole with gonadotropins in intrauterine insemination cycle. International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 15(2), 679–682. https://doi.org/10.18203/2320-1770.ijrcog20260191

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Original Research Articles