Objectives: To compare outcome of intrauterine insemination (IUI) after letrozole (LET) ovarian stimulation (OS) followed by endometrial scratching (ES) versus after each intervention separately.
Patients & Methods: The study included 90 women with primary infertility for >2years secondary to male factor and had previous failed IUI or expectant trials. All women underwent clinical examination and transvaginal ultrasonographic (TVS) examination and hormonal profile. Enrolled couples were randomly divided into three groups: Group L received oral letrozole 5 mg from day 3 to 7 of the menstrual cycle, Group S included females subjected to ES injury and Group LS included females received LET OS followed by ES injury. For all groups, ovulation was monitored and assured using TVS for evident ovulation with a dominant follicle size >18 mm. IUI was repeated for three cycles and clinical pregnancy rate (CPR) and abortion and multiple pregnancy rates were recorded.
Results: Studied women gave 287 follicles of >18 mm with a mean number of follicles of 3.18/female and 1.35/cycle. Mean number of follicles and follicle/cycle. Mean endometrial thickness was significantly lower, while E2 serum levels were significantly higher in women of group S compared to women of other groups. Total CPR was 41.1%/woman and 17.4%/cycle with significant difference in favor of group LS. Two patients of groups L and LE had multiple pregnancy and 5 women had abortion for a rate of 5.6%/woman and 2.3%/cycle.
Conclusion: Letrozole OS did better to prepare for IUI in infertile couple secondary to male subfertility. ES prior to IUI improved the chances of clinical pregnancy and could be an alternative to OS whenever OS had failed or contraindicated. ES after letrozole OS followed by IUI augments the CPR up to 53.3%/patient.