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Int J Clin Exp Pathol 2013;6(6):1157-1163

Original Article
Does progesterone-induced endometrial withdrawal bleed before ovulation induction
have negative effects on IUI outcomes in patients with polycystic ovary syndrome?

Xiyuan Dong, Yu Zheng, Xiuhua Liao, Ting Xiong, Hanwang Zhang

Reproductive Medicine center, Tongji Hospital, Tongji Medicine college, Huazhong University of Science and Technology, Wuhan, The People’s
Republic of China

Received March 17, 2013; Accepted April 21, 2013; Epub May 15, 2013; Published June 1, 2013

Abstract: Polycystic ovary syndrome is a common heterogeneous endocrine disorder in reproductive-age women, with prevalence around 4-
12%. The present study was performed to investigate whether progesterone-induced endometrial bleed before ovulation induction affects
pregnancy in patients with PCOS who underwent intrauterine insemination (IUI) treatment. A total of 241 IUI cycles were retrospectively
analyzed. Patients enrolled in this study underwent ovulation induction with IUI treatment from Jan. 2011 to Dec. 2012. The study group
consisted of 184 cycles with progesterone-withdrawal bleed before ovulation induction. The control group included 57 cycles with spontaneous
menses. The clinical characteristics, ovulation induction parameters and IUI outcomes, such as pregnancy rate and live birth/ongoing
pregnancy rate, were compared between the two groups. We found that patients in induced shedding group had thinner peak endometrium in
ovulation induction cycles. Additionally, the ratio of peak endometrial-thickness to baseline endometrial-thickness was lower in induced
menses patients. However, the pregnancy rate and live birth/ongoing pregnancy rate per cycle were similar with the control group. Excluding the
peak E2 level, peak E2/number of follicles > 15mm and peak endometrial-thickness/baseline endometrial-thickness, no differences were
found in ovulation induction or IUI results between patients used Letrozole or Clomiphene Citrate. In patients undergoing administration with
Letrozole, those taking progesterone had thinner endometrium and lower peak endometrial-thickness/baseline endometrial-thickness.
However, the pregnancy rate and live birth/ongoing pregnancy rate were not statistically different from patients with spontaneous menses. In
conclusion, our study showed that progesterone exerted a negative effect on endometrial development, which seemed to be associated with
reduced pregnancy results in ovulation induction with IUI cycles. (IJCEP1303037).

Keywords: Polycystic ovary syndrome, ovulation induction, endometrial withdrawal bleed, pregnancy rate, live birth/ongoing pregnancy rate,
letrozole

Address correspondence to: Dr. Hanwang Zhang, Reproductive Medicine Center, Tongji Medicine College, Huazhong University of Science
and Technology, Wuhan, People’s Republic of China. Tel (Office): +86-27-83662629; Tel (cell phone): +86-13638610546; E-mail: hwzhang@tjh.
tjmu.edu.cn