Letrozole ovulation induction in clomiphene citrate poor responders polycystic ovary patients

Abstract

Background: Polycystic ovary syndrome is one of the most common endocrinopathy affecting women of reproductive age group with a prevalence of 12-18%. It is a complex syndrome with reproductive, metabolic and psychological features. The aim of current study was to evaluate the effectiveness of use of letrozol (aromatase inhibitor) in induction of ovulation in cases of clomiphine citrate poor responder Polycystic ovary syndrome patients. Methods: Prospective randomized study carried out during the period from January 2008 until April 2011 in Basrah infertility center. In this study 83 patient with primary infertility due to PCOS were treated by clomiphine citrate for 3-6 months. Those who failed to ovulate with clomiphine citrate were given Letrozole in a dose of (2.5-5mg/day from the 2nd to the 6th day of menstrual cycle. When the dominant follicle reached a diameter of 18mm, HCG 10,000IU was given and timed intercourse was advised. Results: In the day of HCG administration, the mean number of follicles ≥18mm was 1.2 (range was 1-2) and the mean endometrial thickness was (9.40±1.3mm). Ovulation occurred in 29 cases (75%) and pregnancy in 9 cases. Conclusion: Letrozole is associated with a higher pregnancy rate in polycystic ovary syndrome patients than clomiphine citrate. It has limited number of mature follicles with less chance of hyperstimulation or multiple pregnancies. In addition, induction of ovulation with Letrozole is associated with no adverse effect on endometrium or cervix. It is safe, easily administrated, cost-effective and may be a good alternative for clomiphine citrate poor responder cases before using expensive and risky gonadotropins.