Belgin Savran UÇOK, Türkan Dikici AKTAŞ, Emel OZALP, Dilruba Ravza NALBANTÇILAR, Dinçer SÜMER, Murat Levent DERELİ, Özgür Volkan AKBULUT, Kubilay ÇANGA, Mustafa BAĞCI
Eastern Journal of Medicine (EJM) - 2026;31(1):139-145
To compare the effects of three different ovulation induction protocols (clomiphene citrate (CC), letrozole, and gonadotropin) on pregnancy outcomes in women diagnosed with unexplained infertility undergoing intrauterine insemination (IUI). This retrospective observational cohort study was conducted at the Infertility Unit, Department of Obstetrics and Gynecology, Etlik City Hsopital. A total of 156 women aged 18-42 years with unexplained infertility who underwent IUI between January 2022 and December 2024 were included. Ovarian stimulation was performed using CC, letrozole, or gonadotropins. Clinical pregnancy was confirmed using serum beta-hCG followed by transvaginal ultrasound. Independent predictors of pregnancy were identified through multivariate logistic regression, adjusting for age, FSH, AMH levels, and the induction protocol used. Pregnancy was achieved in 21 women (13.5%). Those who conceived had significantly lower FSH levels than those who did not (median 5.4 vs. 6.0 IU/L, p = 0.046). Letrozole use was notably more common among women who became pregnant (76.2% vs. 44.4%, p = 0.025). In multivariate analysis, letrozole remained an independent predictor of clinical pregnancy (adjusted OR: 3.589, 95% CI: 1.229-10.480, p = 0.019), while higher FSH levels were associated with a decreased likelihood of pregnancy (adjusted OR: 0.744, 95% CI: 0.557-0.996, p = 0.047). In women with unexplained infertility, ovulation induction with letrozole prior to IUI is associated with higher pregnancy rates compared to other protocols. Considering its cost-effectiveness, lower risk of multiple pregnancies, and favorable endometrial effects, letrozole should be considered as a first-line treatment option in appropriate patients.
