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Objective: The aim of the study was to explore the efficacy of glucocorticoid in folliculogenesis and ovulation during induction of ovulation by letrozole in polycystic ovarian syndrome (PCOS). Materials and methods:This experimental study was conducted in Dhaka Medical College and Hospital and Infertility Care and Research Centre (ICRC) Dhaka, Bangladesh. Two hundred and eighty infertile patients with PCOS, who failed to ovulate by letrozole 10 mg/day for 5 days were the target population of this study. The patients received glucocorticoid (Dexamethasone) 0.5 mg every alternate day from D2 of the cycle till D10 along with same dose of letrozole in subsequent cycles. Only letrozole-treated cycles were taken as control and letrozole plus glucocorticoid-treated cycles were taken as experimental. Monitoring was done by transvaginal ultrasonography. Six ovulatory cycles were observed for pregnancy. Main outcome measures were ovulation and pregnancy.Results: Baseline characteristics were similar as same patients were taken as control and experimental. One hundred and eighty-two (65%) patients were ovulated and 93 (33.21%) patients got pregnant after addition of glucocorticoid. Conclusion:In PCOS addition of glucocorticoid during induction of ovulation appears to cause significant improvement in folliculogenesis, ovulation and pregnancy.

Anovulation accounts for around 20% cases of infertility even when other fertility factors are normal. Clomiphene Citrate (CC), the oral anti-estrogen has long been used as the first line drug for induction of ovulation. Clomiphene is associated with a high ovulation (60-80%) but relatively poor pregnancy rate (30-40%). CC leads to long lasting estrogen receptor depletion. Because of its long half-life (2 weeks), CC possibly exerts a negative feedback effect on the cervical mucous and endometrial development with subsequent implantation failure. The aromatase inhibitor letrozole (originally approved for use in postmenopausal women with breast cancer to suppress estrogen production) is now increasingly being used by fertility specialists worldwide for ovulation induction.With a halflife of around 45 hours, letrozole possibly avoids the adverse effects of CC on endometrium. Preliminary trials have shown impressive prospects of aromatase inhibitor letrozole for induction of ovulation (even in CC resistant cases) with satisfactory pregnancy rates. Letrozole is now being marketed by our local pharmaceutical companies. Though large scale randomized controlled trials are not yet available, letrozole holds a very promising chance of replacing CC in near future. DOI: 10.3329/jbcps.v28i1.4642 J Bangladesh Coll Phys Surg 2010; 28: 40-44

Objective To assess the efficacy of aromatase inhibitor letrozole for induction of ovulation in anovulatory polycystic ovary syndrome (PCOS) patients in whom clomiphene citrate (CC) treatment was unsuccessful. Design Prospective, nonrandomized, interventional, crossover trial, using anovulatory PCOS infertile patients previously treated with clomiphene citrate as their own historic controls. Setting Center for Assisted Reproduction (CARE), Department of Obstetrics and Gynecology, Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM), Dhaka, Bangladesh. Patients 60 anovulatory PCOS infertile patients who received 150 mg of clomiphene citrate for at least 4 cycles on days 2 to 6 of the cycle with an unsatisfactory outcome (No mature follicle and/or endometrial thickness of equal or less than 0.7 cm) were the target population. Intervention 5.0 to 7.5 mg of letrozole was given orally on days 2 to 6 of the cycle. Main outcome measures: Number and size of mature follicles, endometrial thickness and occurrence of ovulation. Results There was a statistically significant increase in the follicular size and endometrial thickness after the administration of letrozole. Ovulation occurred in 38 patients (63.33%) in the letrozole treated cycles. Most of developed follicles (68.42%-26 patients) were multiple and majority patients (63.16%) responded to the higher 7.5 mg dose. Conclusion Oral administration of letrozole is an effective agent for ovulation induction in clomiphene citrate resistant PCOS patients.