TITLE:
Simultaneous Letrozole and Clomiphene Citrate versus Letrozole Alone in Clomiphene Citrate Resistant Polycystic Ovary Syndrome: A Randomised Controlled Trial
AUTHORS:
Mohamed A. Ibrahem
KEYWORDS:
Ovulation Induction, Letrozole, Clomiphene Citrate, Polycystic Ovary Syndrome
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.9 No.11,
November
27,
2019
ABSTRACT: Background: Polycystic ovary syndrome (PCOS) is a common cause of anovulatory
infertility. The therapeutic strategies for clomiphene
citrate (CC)- resistant patients include the addition of corticosteroids, extended
duration of clomiphene, gonadotrophin therapy, laparoscopic ovarian drilling, in vitro fertilization or the use of
aromatase inhibitors recently. Letrozole decreases estrogen levels in the body,
so it releases the hypothalamus and/or pituitary gland from the negative
feedback of estrogen. This increases levels of gonadotrophins, which stimulates
follicular growth. Objectives: To evaluate the role of letrozole alone
and simultaneous use of letrozole and clomiphene citrate (CC) for ovulation induction in patients with clomiphene citrate-resistant PCOS (CCR-PCOS). Patients and Methods: This open-label randomised
controlled study was conducted in the Department of Obstetrics and Gynecology,
Faculty of Medicine, Zagazig University, Egypt during
the period from February 2018 to June 2019. The study included 60 CCR-PCOS
patients who were randomly allocated by independent personnel into two arms: group A
(letrozole alone) or B (letrozole + CC). In either
group, monitoring the mean follicular diameter and endometrial thickness in the
days 10, 12, and 14 of the cycle by
transvaginal ultrasound and Measurement of serum Progesterone (ng/ml) 7 days after the expected time
of ovulation. Results: We investigated various clinical and sonographic factors that may predict
the outcome of the method of induction of ovulation in CCR-PCOS with no
significant affection for the results. There was
a non-significant difference between the studied groups regarding ovulation and
pregnancy per cycle or per patient. Conclusion: Letrozole alone or
simultaneous use of letrozole and CC offers a good second-line option for
induction of ovulation in CCR-PCOS patients.
However, the combination of CC and letrozole did not add any benefit over the
use of letrozole alone regards ovulation rate, follicular volume, endometrial
thickness, pregnancy rate and live birth rate.