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Article Type

Original Study

Abstract

Objective The objective of this study was to determine first-line infertility therapy in polycystic ovarian syndrome (PCOS) and to compare between clomiphene citrate (CC) and aromatase inhibitors (letrozole) as the standard treatment. Patients and methods This is a prospective randomized study. The study was conducted at El-Galaa Assisted Reproduction Unit, El-Galaa Maternity Teaching Hospital, Cairo, Egypt. Eighty-eight women with PCOS were randomized into two groups. Rotterdam criteria were used to define PCOS: oligomenorrhea less than or equal to 8 menses/year plus either PCOS on ultrasound or clinical/biochemical hyperandrogenism, with the exclusion of other causes. Forty-four patients were randomized to the letrozole group (82 cycles), and the other 44 were randomized to the CC group (78 cycles). The aromatase inhibitor letrozole (5 mg/day) and CC (100 mg/day) were administered orally on days 3–7 of menses. Results Number of follicles, endometrial thickness, estradiol levels on human chorionic gonadotropin day, and pregnancy rates were measured in both groups. The mean age, parity, and duration of infertility in both groups were similar. The number of follicles sized more than 15 mm in diameter was statistically significantly higher in the CC group (3.4 ± 0.4 vs. 2.03 ± 0.2). Ovulation occurred in 68.2% (56/82) of letrozole cycles and 74.3% (58/78) of CC cycles without a statistically significant difference. Median serum estradiol concentrations were significantly higher in the CC group than in the letrozole group (396 ± 84.4 vs. 266.2 ± 55.1 pg/ml). Endometrial thickness by transvaginal ultrasound at the time of human chorionic gonadotropin administration was not statistically significantly different in the two groups (7.8 ± 2.2 and 8.1 ± 1.2 mm in letrozole and CC groups, respectively). The pregnancy rate per cycle was 9.7% in the letrozole group and 7.6% in the CC group without significant statistical difference between the groups. Conclusion Both letrozole and CC have comparable results, with no specific advantage of one over the other for ovulation induction in women with PCOS.

Keywords

Clomiphene citrate, letrozole, pcos, pregnancy

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