• Hatem Abu Hashim, Mohamed El Rakhawy, and Ibrahim Abd Elaal.
• Department of Obstetrics & Gynecology, Mansoura Faculty of Medicine, Mansoura University, Egypt. hatem_ah@hotmail.com
• Acta Obstet Gynecol Scand. 2012 Mar 1;91(3):338-45.

ObjectiveTo evaluate pregnancy rates with letrozole and clomiphene citrate (CC) alone for superovulation in an intrauterine insemination program for women with recently surgically treated minimal to mild endometriosis.DesignA randomized controlled trial following the CONSORT criteria.SettingUniversity teaching hospital and a private practice setting.Patients136 women with primary infertility due to minimal to mild endometriosis who did not achieve pregnancy after six to 12 months following laparoscopic treatment.InterventionsSuperovulation using 5 mg letrozole/day (69 women, 220 cycles) or 100 mg CC/day (67 women, 213 cycles) for five days combined with intrauterine insemination up to four cycles.Main Outcome MeasuresClinical pregnancy rate per cycle, cumulative pregnancy rate after four cycles, number of follicles, serum estradiol, endometrial thickness on the day of human chorionic gonadotropin administration, serum progesterone, miscarriage and live birth rates.ResultsThe clinical pregnancy rate per cycle and the cumulative pregnancy rate after four cycles were comparable (15.9 vs. 14.5% and 64.7 vs. 57.2%; p=0.82, p=0.71 in letrozole and CC groups, respectively). Two twin pregnancies occurred in the CC/intrauterine insemination group. Miscarriage and live birth rates were comparable (11.4 vs. 12.9% and 44.9 vs. 40.3%; p=0.47, p=0.62 in letrozole and CC groups, respectively). The total number of follicles and serum estradiol on the day of human chorionic gonadotropin administration were significantly increased in the CC group.ConclusionsSuperovulation with letrozole is not more effective than clomiphene citrate alone in an intrauterine insemination program for women with minimal to mild endometriosis who did not achieve pregnancy after six to 12 months following laparoscopic treatment. ClinicalTrials.gov ID: NCT01334762.© 2012 The Authors Acta Obstetricia et Gynecologica Scandinavica© 2012 Nordic Federation of Societies of Obstetrics and Gynecology.

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