الفهرس 
Initial Recommendations Concerning Infertile CouplesOnly 14 pages are availabe for public view
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Abstract
Unexplained infertility is diagnosed when all of the standard elements of the infertility evaluation yield normal results. The incidence of unexplained infertility ranges from 10% to as high as 30% among infertile populations, depending on diagnostic criteria. At a minimum, the diagnosis of unexplained infertility implies a normal semen analysis, objective evidence of ovulation, a normal uterine cavity, and bilateral tubal patency (Speroff, 2005).
No uniform treatment protocol has been yet proposed for unexplained infertility. Woman often resist treatment undergoing in vitro fertilization (Collins, 2003).
In the absence of a correctable abnormality, the therapy of unexplained infertility is empiric (Collins, 2003).
Ovarian stimulation is a way of treatment that might be used as a first line of treatment in young woman with unexplained infertility (Dankert et al., 2007). Clomphine appears to be superior to no treatment or placebo (Hughes et al., 2000) however, the risk of clomiphene citrate therapy include an increase in multiple pregnancy rates and a slight risk of ovarian hyperstimulation syndrome (Schenker et al., 1981). In addition, clomphine citrate has a long half-life and may have a negative effect on the cervical mucus and endometrium (Casper and Mitwally, 2006).
Aromatase inhibitors have been used successfully in women with advanced breast cancer (Mauri et al., 2006).
Recently they are used to induce ovulation; they suppress estrogen production, have a reduced half-life, lack the
persistant antiestrogenic effect of clomphine citrate in the late follicular phase, and may have less adverse effects compared to clomiphene citrate (Casper and Mitwally, 2006).
Aromatase inhibitors in women with polycystic ovary syndrome might achieve pregnancy rates higher than clomiphene citrate (Polyzos et al, 2008). And are relatively safe agents regarding newborns (Tulandi et al, 2006).
The aim of the work is to compare the effectiveness of aromatase inhibitors to clomphine citrate for ovulation induction in women with unexplained infertility.
This study was conducted at Ain Shams University Maternity Hospital during the period between February 2010 and September 2010. A total of 150 women with unexplained infertility were included in the study. They were randomized into 2 groups: group I (Clomiphene Citrate group) [n=75] including women who received clomiphene citrate 100 mg orally from cycle day 3 to cycle day 7; and group II (Aromatase Inhibitors) [n=75] including women who received letrozole 2.5 mg orally from cycle day 3 to cycle day 7.ovulation monitoring by transvaginal ultrasonographic folliculometry.
Once the dominant follicle reached a size of 18 mm, the endometrial thickness were assessed and hCG 10.000 IU was given intramuscular to trigger ovulation and timed intercourse was advised, eight patient of each group get IUI.
The mean endometrial thickness at reaching mature follicle(s) was significantly higher in women of group II (Aromatase Inhibitor Group) when compared to women of group I (Clomiphene Citrate Group) [9.18 ± 0.24 mm vs. 7.23 ± 0.24 mm, respectively, p<0.001].
The median no. of mature follicles was significantly higher in women of group I (Clomphine Citrate Group) when compared to women of group II (Aromatase Inhibitor Group) [2 (1 – 2) vs. 1 (1 – 1) respectively, p<0.001].
Of the included 150 women, 20 (13.3%) women had positive serum pregnancy test. The proportion of women who conceived was slightly higher among women of group II (Aromatase Inhibitor Group) when compared to women of group I (Clomiphene Citrate Group) [11/75 (14.7%) vs. 9/75 (12%), respectively, p>0.05]; the difference, however, was not statistically significant.
The pregnancy outcome in intercourse and IUI groups among clomid-treated patients. Intercourse group, only 5 cases (7.46%) showed successful outcome, while the rest of cases (62 out of 67; 92.54%) showed failure pregnancy outcome. On the other hand, in IUI group, 4 cases (50.00%) showed successful pregnancy outcome and the remaining 4 cases (50%) showed failure pregnancy outcome. A highly significant difference was found between intercourse group and IUI group in clomid-treated patients.
The pregnancy outcome in intercourse and IUI groups among aromatase-treated patients. In intercourse group, only 8 cases (11.94%) showed successful pregnancy outcome, while the rest of cases (59 out of 67; 88.06%) showed failure pregnancy outcome. On the other hand, in IUI group, 3 cases (37.50%) showed successful pregnancy outcome and the remaining 5 cases (62.50%) showed failure pregnancy outcome. A non significant difference was found between intercourse group and IUI group in aromatase-treated patients.