Study the Estradiol Add-on Benefit with Oral Ovarian Induction Medication in Subfertile Patients with PCOS or Unexplained Subfertility
Background: Estrogen might help when there is a decrease in estrogen quantity or increase in estrogen receptor antagonization. These effects occur when we use oral agents for ovulation induction. The use of estradiol add-on needs more research to assess its value in ovulation induction. Doppler studies might be beneficial in the management of subfertility. Methods: This study is a randomized prospective study. We recruited subfertile Patients with PCOS or unexplained subfertility from the infertility unit at Al-Moosa Specialist Hospital in eastern province in the Kingdom of Saudi Arabia. We randomized patients into four groups: clomiphene group, letrozole group, clomiphene with estrogen add-on group or letrozole with estrogen add-on group. We did a uterine and sub-endometrial doppler study on the hCG trigger day and on the mid-luteal phase day. We also studied endometrial thickness, pattern and vascularity zones. Results: When adding estradiol, there was a high cancellation rate for both clomiphene and letrozole groups (27.8%, 46.67% respectively) with a p-value of (0.007, 0.001 respectively). Conclusions: When using oral ovulation induction medications, it is not wise to add estradiol from day nine till ovulation day as it will be associated with a high cancellation rate.