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Ovulation induction remains a milestone in the treatment of women with anovulatory infertility. For the last 40 years, the first line of treatment for anovulation in infertile women was CC, it was appropriate, because the drug was highly effective in inducing ovulation in selected patients with the advantages of being orally administered, relatively safe, and inexpensive. In spite of the high ovulation rate associated with the use of CC (60–80%), the pregnancy rate is much lower (around 20–40%). Moreover, there may be a higher than expected incidence of miscarriage in conception cycles following CC treatment.
Such discrepancy is believed to be due to its peripheral anti-estrogenic effect of CC, particularly at the level of the cervical mucus and endometrium. In addition to discrepancy between ovulation and pregnancy rates, a 20 to 25% of anovulatory women are resistant to CC and fail to ovulate at doses up to 200 mg daily.
AI (letrozole) have been introduced as a new treatment option that could challenge CC for ovulation induction. AIs are a new group of drugs join the fertility treatments. They are orally administered, easy to use and less expensive than other measurements like gonadotrophines, but more expensive than CC, and with minor side effects. Letrozole is a simple oral alternative to CC with no adverse effect on the endometrium and endocervix avoiding the risk of multiple pregnancy and ovarian hyper-stimulation syndrome.
TMX have been also introduced as a simple oral alternative to CC in ovulation induction. It is similar in structure to CC, but with no peripheral anti-estrogenic actions, so, has no adverse effects on endometrial thickness and cervical mucus.
In our study, we tried to compare the effect of CC, letrozole and TMX on the endometrium in anovulatory patients using endometrial thickness and spiral artery Doppler as parameters for comparison during ovulation induction cycle.
Our study revealed that:
• Enometrial thickness was better under letrozole and TMX therapy.
• Spiral artery Doppler shows lower impedance with a lower RI and PI under letrozole and TMX therapy.
• Ovulation rate was not significantly different between the three drugs.
• Pregnancy rate was not significantly different between the three drugs.