In unexplained infertility with young age is gonadotrophin is a better choice than CC more so if IUI is planned ?? What is the members
experience on which day they suggest start gonadotrophins?
Ans:-If she is below 26 yrs and trying time is less than 3
years, I shall certainly initially opt for prescribing at least three cycles of
Letrozole / CC along with serial follicular monitoring & serum P test in
midluteal phase. What is more relevant is to counsel the couple in advance
about limitation about the success rate of Letrozole /CC vis a vis the risk
factors / cost involved in Gonadotropin only cycles and its inherent risk of
OHSS/Multiple gestations /increased risk of miscarriage/ possible increased
risk of CM of foetus.
Most patients after
due counseling will opt for first few cycles of Letrozole / CC.
As we know that
so called unexplained subfertility as we
level casually are due to “minimal endometriosis” followed by “sperm / oocyte dysfunction."
It goes without
saying that one can plan letrozole in IUI cycles along with Gonadotrophins cycles ..
Between IUI and planned relation-IUI will yield better success. The problems
with gonadotrophins cycles , as mentioned earlier are 1) hyperstimulation syndrome (OHSS) and 2)
multiple pregnancies 3) cost of drugs and monitoring The other drawbacks: - 4) increased miscarriage rate and congenital
abnormalities.
There are RCT
comparing these success rates in Letrozole / CC versus only GN cycles along with IUI ? The biggest
meta-analysis on unexplained infertility has concluded that CC is not useful
and in fact detrimental in cases of unexplained infertility...and it's better
to hope for an expectant management than CC cycle in these couples
No comments:
Post a Comment