| Objectives:1. To evaluate the effects of endometrial receptivity after treatment with letrozole(LE) or clomiphene citrate(CC) on the ovulation induction by transvaginal colour doppler sonography, which detected the patients endometrial morphology, thickness and blood flow on the day of HCG administration.2. To investigate the clinical effects of using letrozole merely on the ovulation induction in endometrial preparation for frozen-thawed embryo transfer.Methods:1. Sixty polycystic ovarian syndrome(PCOS) patients, who were accorded with the inclusion criteria, were divided into two groups by case control study from January2010to October2011. The patiens of the two groups were given letrozole2.5-5mg/day (LE group) or CC50-100mg/day (CC group) from cycle3to7respectively. All patients were detected by the same doctor with transvaginal colour doppler sonography on the day of HCG administration. The endometrial morphology and thickness and blood flow and cililical outcomes were compared.2. Two hundred and fifty three FET cycles, who were accorded with the inclusion criteria, were analyzed by case control study from October 2010to June2011. All ovulation disorders or menstrual disorders were divided into two groups:the group of letrozole ovulation induction cycle (n=85), the group of hormone replacement therapy (HRT) cycle (n=84). During the same period, those who ovulated normally were included in natural cycle group(n=84), The patients’demographics and the clinical parameters such as biochemical and clinical pregnancy rates etc were observed and compared among these different groups.Results:1. There were no significant differences in all patient’s general information such as age, duration of infertility, body mass index(BMI). The mean number of mature follicles was less in LE group than that in CC group(1.05±0.255vs2±0.85, P<0.05). The Serum estradiol level was less in the LE group (286.52±135.75vs620±289.0, P<0.01) and the endometrial thickness was higher in the LE group (10.28±0.31vs7.05±0.19, P<0.01) than that in the CC group on the day of HCG administration. The PI and SI of the uterine artery and subendometrial artery were less in the LE group than that in CC group.The clinical pregnancy rate(35.17%vs20%) was higher and abortion rate (6.67%vs25%) was less in the LE group than that in CC group. The differences were significant.2. Reproductive clinical parameters such as patient’s age, duration of infertility, the rate of embryo implantation, biochemical pregnancy,multiple pregnancy, abortion, ectopic pregnancy had no significant differences(P>0.05) in different protocols of endometrial preparation for FET. Endometrial thickness(10.38±1.363vs9.89±1.073) on transfer day and clinical pregnancy rate(54.1%vs44.04%)in letrozole cycle group were higher than that in HRT cycle group. The differences were significant (P<0.05), but there were no significant differences between the letrozole and natural cycle groups. Differences of the number of development follicles, endometrial thickness on HCG administration day and follicle growth days were no significant between the letrozole and natural cycle groups(P>0.05). The estradial level(341.19±113.14pg/mlvs279.70±127.80pg/ml) on HCG administration day in natural cycle group was higher than that in the letrozole cycle group, and the mean diameter of maturation follicles in natural cycle was less than that in letrozole cycle group. The differences were significant (P<0.05).Conclusion:1. Letrozle on the ovulation induction can improve the endometrial recepticity in PCOS patients. The clinical outcomes of those who using letrozle were superior to clomiphene citrate. Transvaginal colour doppler sonography is an effective and noninvasive approach to evaluate the endometrial receptivity.2. Letrozole on the ovulation induction for endometrial preparation is superior to HRT in FET and it has similar clinical process and outcomes to the natural cycle, therefore letrozole can be applied in endometrial preparation for FET effectively to those patiens who are anovulation or present menstrual disorder. |
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