COMPARISON OF EFFICACY OF LETROZOLE AND CLOMIPHENE CITRATE IN OVULATION INDUCTION IN PAKISTANI WOMEN WITH PCOS

Objective: To compare the effects of letrozole (5 mg) and clomiphene citrate (100 mg) for ovulation induction in women with polycystic ovary syndrome (PCOS). Design: Prospective randomized trial. Setting.Tertiary care hospitals of Sialkot and Gujrat,Pakistan. Patient(s): The study comprised a total of 110 infertile women with PCOS. Intervention(s): Patients were randomized to treatment with 5 mg of letrozole daily (60patients) or 100 mg of clomiphene citrate daily (50 patients) for 5 days starting on day 3 of menses. Intercourse time was decided 24 to 36 hours after hCG injection. Main Outcome Measure(s): Number of follicles, Duration of stimulation (d), endometrial thickness, and pregnancy and miscarriage rates. Result(s): In both groups mean age, parity, and duration of infertility were similar. The total numbers of follicles during stimulation were similar between the two groups (5.7 ±0.3 in the letrozole group, 4.5 ± 0.4 in the CC group). The number of follicles >14 mm and 18 mm were significantly higher in the letrozole group. The duration to reach a dominant follicle was 9.6 ± 0.4 days in the letrozole group and 10.8 ± 0.9 days in the CC group .there was no significant difference in the endometrial thickness between the two groups. The pregnancy rate per cycle was 15.5% in the letrozole group and 12% in the CC group. Twenty pregnancies in letrozole group are presently ongoing. 6 of 20 pregnancies in the CC group resulted in a miscarriage. No miscarriage was see in the letrozole group, but we encountered two ectopic pregnancies. Conclusion: In conclusion, the results of this study suggest that letrozole, are safe and equally efficacious to clomiphene citrate in terms of ovulation. Higher miscarriage were seen in CC group participants but both CC and letrazole groups had same preganancy rates among PCOS women. Key words: Superovulation, ovulation induction, PCO