Letrozole versus clomiphene citrate for ovulation induction in anovulatory women with polycystic ovarian syndrome: A randomized controlled trial

Abstract

Objective To compare the efficacy of letrozole and clomiphene citrate (CC) for ovulation induction in infertile women with polycystic ovarian syndrome (PCOS). Methods In this assessor blind, randomized controlled trial, 90 infertile women with PCOS were randomized to receive either letrozole or CC for ovulation induction in incremental doses for a maximum of three cycles. Main outcome measures studied were endometrial thickness, ovulation rate, pregnancy rate, rate of monofollicular development, and time to conception. Results Mean endometrial thicknesses were 9.86 ± 2.32 mm and 9.39 ± 2.06 mm with letrozole and CC, respectively (P=0.751). Cumulative ovulation rates were 86.7% and 85.2% with letrozole and CC, respectively (P=0.751). Pregnancy was achieved in 42.2% of women in the letrozole group and 20.0% of women in the CC group (P=0.04). Monofollicular development was seen in 68.4% of ovulatory cycles in the letrozole group compared with 44.8% in the CC group (P=0.000). Mean time to achieve pregnancy was significantly shorter (log rank P=0.042) with letrozole (9.65 weeks) than with CC (11.07 weeks). Conclusion Letrozole is a better alternative for ovulation induction in anovulatory women with PCOS as pregnancy rates are higher, time to pregnancy is shorter, and chances of multiple pregnancy are less because of high monofollicular growth.

A Randomized Cohort Study: Is It Worth the Time to Receive Antiandrogenic Pretreatment Before Ovulation Induction for Women With Polycystic Ovary Syndrome?

“…Conception was determined as a positive result of human chorionic gonadotropin (hCG) with the values > 10 mIU/mL following ovulation induction ( 27 ). Ongoing clinical pregnancy was defined as a clinical pregnancy that continued for 12 weeks of gestation ( 28 ). The definition of live birth was an infant born alive after 28 weeks of gestation.…”

Successful pregnancy with restorative reproductive medicine after 16 years of infertility, three recurrent miscarriages, and eight unsuccessful embryo transfers with in vitro fertilization/intracytoplasmic sperm injection: a case report

“…We commenced treatment as follows: Follicle stimulation with letrozole [ 11 ] 17.5 mg daily × 3 days from day 3 of the cycle HCG 10,000 iu trigger mid cycle with 20 mm mature follicle Progesterone pessaries (Cyclogest) 400 mg nightly for 10 nights from day 3 after ovulation Prednisolone 5 mg [ 12 ] every morning Naltrexone 4.5 mg nightly Supplements with vitamin D3 4000 iu, omega 3 1000 mg, and folic acid 0.4 mg Dietary strategy of low carbohydrate intake with minimal dairy and wheat Metformin 500 mg twice daily with food …”

Therapeutic Potentials of Low-Dose Tacrolimus for Aberrant Endometrial Features in Polycystic Ovary Syndrome

“…Current consensus guidelines and clinical accord on the management of anovulatory infertility in women with PCOS focus largely on improving ovulatory function and managing oligo- or anovulation-related subfertility [ 5 , 70 ]. Therefore, irrespective of their FDA-approval status, current therapeutic interventions for PCOS include lifestyle modification and weight management, as well as drugs that induce ovulation, such as clomiphene citrate (CC) and aromatase inhibitors (such as letrozole and/or anastrozole) [ 71 , 72 , 73 , 74 ]. Additionally, combined oral contraceptive pills (OCPs) have been used to improve hyperandrogenism in women with PCOS [ 75 ], and for its demonstrated clinical and metabolic benefits improving ovulation and menstrual frequency in anovulatory PCOS patients, the insulin-sensitizing agent metformin has also been prescribed [ 76 ].…”