December 20, 2015
- Posted by: emobile
- Category: Trending Issues
READ WHAT A STUDY SUGGESTS FOR UNEXPLAINED INFERTILITY.
It is the usual standard practice of most fertility experts to use gonadotropin or clomiphene citrate for infertility cases in couples. A recent research proposes ovarian stimulation with letrozole to reduce multiple gestations while maintaining live birth rates.
The researchers argued that the high cost and limited insurance coverage of IVF in most places; United States especially and here in Nigeria, to mention a few, make IVF an unattainable option for most infertile couples. This formed the basis of the research and suggests Empirical ovarian stimulation to promote childbearing by simply increasing the number of ova ovulated, as well as possibly by enhancing implantation, placentation, or both through hormonal effects on the endometrium.
The research suggests the use of Aromatase inhibitors to induce ovulation in women with the polycystic ovary syndrome. This has recorded great success which means that aromatase inhibitors may be effective alternative agents for ovarian stimulation in couples with unexplained infertility . The usage is reported to be associated with monofollicular development which in most cases may result in enhanced fertility and a reduced risk of ovarian hyperstimulation and multiple births; when compared the current standard therapies such as gonadotropin and clomiphene.
The use of an aromatase inhibitor to promote conception has not been associated with any significantly increased risk of congenital anomalies.
They however recognized the complication caused by clomiphene and or gonadotropin i.e. the ovarian hyperstimulation syndrome leading to multiple gestations, with an increased risk of preterm birth and associated neonatal morbidity and costs.
A total number of 900 couples with unexplained infertility were used for this research. The age of the women were between 18- 40 with regular messes, normal uterine cavity with at least one patent fallopian tube. While their male have semen specimen of at least 5million sperm per millimeter as suggested by WHO.
The study shows that the rate of multiple gestations were not significantly reduced among women treated with letrozole for ovarian stimulation, as compared with a combined group of women receiving current standard therapy (gonadotropin or clomiphene).
Similar multiple-gestation rate in the letrozole group and clomiphene group were significantly lower than the rate in the gonadotropin group .
Gestation is higher in gonadotropin than in clomiphene.
letrozole group has at satisfying rates of conception, clinical pregnancy, and live birth that were statistically non inferior to the rates with clomiphene.’
However, clomiphene and letrozole each resulted in significantly lower rates of conception, clinical pregnancy, and live birth, as compared with gonadotropin’. This is in contrast to many reports in the literature who have suggested a similar or improved pregnancy rate with an aromatase inhibitor, as compared with standard therapy. Another possibility is that aromatase inhibition, led to lower androgen levels in women with unexplained infertility and to higher androgen levels in those with the polycystic ovary syndrome, resulted in differential elevations of tissue androgen levels in the hypothalamus, pituitary, ovary, or endometrium.
The study was able to show that ‘letrozole was not associated with increased risks of serious adverse maternal, fetal, or neonatal outcomes, as compared with the risks in the gonadotropin and clomiphene groups combined.’
In conclusion, the ‘study involving couples with unexplained infertility with the use of letrozole for ovarian stimulation resulted in significantly reduced rates of ongoing clinical pregnancy and live birth, but not of multiple gestations, as compared with a combined group receiving standard therapy (gonadotropin or clomiphene), but the two comparators had different effects on these outcomes. As compared with the usage of gonadotropin, the use of letrozole resulted in lower rates of live birth and multiple gestation, whereas the rates of these outcomes did not differ significantly between letrozole and clomiphene.
A journal of Obs & Gyn (A work of Michael P etal.)
The new England of Journal of Medicine British
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