Clomiphene Citrate or Letrozole for Ovulation Induction in Women with Polycystic Ovarian Syndrome: A Prospective Randomized Trial (original) (raw)
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Faridpur Medical College Journal
Polycystic Ovarian Syndrome (PCOS) is the most common endocrine disorder responsible for subfertility in young women. The aim of the study was to compare the efficacy of Letrozole over Clomiphene citrate (CC) for ovulation induction in patients with PCOS. It was a prospective randomized trial in a private practice setting. The study period was 3 years, which includes 240 sub fertile patients with PCOS. Patients were divided into two groups. Group-A: 120 patients got Letrozole (2.5 mg) tab, 2 tabs once daily from D2-D6 for 3 cycles. Group-B: 120 patients took tab. Clomiphene citrate (50mg), 2 tabs once daily from D2-D6 for 3 cycles. Trans-vaginal ultrasound was done on D12-D13 to document number of follicles, measurement of dominant follicle and endometrial thickness. Ovulation and pregnancy rate was measured. Results showed that Letrozole have significantly better effect on endometrial thickness (Let 9.2 mm vs CC 8.1mm) and pregnancy rate (Let 44% vs CC 24%). In CC, multiple follicl...
Azerbaijan Pharmaceutical and Pharmacotherapy Journal, 2022
Introduction: Polycystic Ovary Syndrome (PCOS) is a complex and prevalent endocrine disorder that affects approximately 6-12% of women of reproductive age worldwide. Objective: The main objective of the study is to find the long-term effects of letrozole versus clomiphene citrate on ovulation induction in women with polycystic ovary syndrome. Methodology: This prospective study was conducted at Medical and Dental College Sargodha during June 2020 to June 2021 to compare the long-term effects of Letrozole and Clomiphene Citrate on ovulation induction in women diagnosed with Polycystic Ovary Syndrome (PCOS). A total of 185 women with PCOS, aged between 18 and 35 years, who sought treatment for infertility were enrolled in the study. Results: The Letrozole group demonstrated a significantly higher ovulation rate compared to the Clomiphene Citrate group. Specifically, ovulation occurred in 80% of the cycles in the Letrozole group (n = 74) versus 65% of the cycles in the Clomiphene Citrate group (n = 60). The difference was statistically significant (p = 0.02), indicating that Letrozole was more effective in inducing ovulation in women with PCOS. Conclusion: It is concluded that Letrozole is a superior option for ovulation induction in women with PCOS, offering higher ovulation and pregnancy rates, a more favorable endometrial environment, and fewer adverse effects compared to Clomiphene Citrate.
IP innovative publication pvt ltd, 2020
Aim: To compare the role between Clomiphene Citrate & letrozole for infertile patients with Polycystic Ovary Syndrome as an ovulation induction agent & which drug can be chosen as a first line ovulation induction agent in future. Materials and Methods: This prospective study was carried at SSIMS & RC OBG OPD. Total 50 patients of PCOS (diagnosed by Rotterdam criterion) were included in this study. In this clinical trial out of 50 patients, 25 patients received Clo miphene Citrate 100mg (n=25) and rest 25 patients received Letrozole 2.5mg (n=25) daily since day 2-6 or3-7 of menstrual cycle. Follicular respose was carried out from day 9 by trans-vaginal sonogram till atleast 1 mature follicle (18-22mm) was detected & hCG was administered at a dose of 5000 IU. Timed intercourse was advised 24-36 hours after hCG injection. The number of Follicles, Endometrial Thickness, Ovulation rate & Pregnancy rate were measured in both groups. Result: Monofollicular development was statistically significantly, greater in the Let group (CC 61.9%, Let 86.9%). There was also statistically significant difference between the two groups in endometrial thickness (CC 7.861.25mm, Let 9.181.49mm). Similarly, The ovulation rate was 84%% in CC group and 92% in Let group. The pregnancy rate was 20% in CC group and 36% in Let group. Conclusion: Letrozole might be an acceptable alternative to clomiphene citrate to induce ovulation and pregnancy in PCOS patients.
Pakistan Journal of Medical Sciences
Objectives: To compare the efficacy of letrozole (LTZ) vs clomiphene citrate (CC) for ovulation induction in patients having polycystic ovarian syndrome (PCOS). Methods: This randomized controlled trial was conducted at The Department of Obstetrics & Gynecology, Nishtar Medical University Hospital, Multan, Pakistan from January 2021 to June 2021. A total of 78 women aged 18 to 30 years, diagnosed having PCOS were enrolled. In Group-A, 39 women were given LTZ, 5mg for five days of menstrual cycle. In Group-B, 39 women were given CC, 100mg for five days of menstrual cycle. All patients underwent transvaginal scan (TVS) for the evaluation of efficacy in terms of ovulation induction. Results: Overall mean age was noted to be 25.41±2.84 years. Most of the patients, 51 (65.4%) belonged to rural area of residence. There were 52 (66.7%) patients with BMI less than 25 kg/m2. Overall, mean duration of infertility was found to be 2.62±0.74 years. Among 70 patients who completed the follow ups ...
Open Journal of Obstetrics and Gynecology, 2013
Background: The purpose of this study was to compare the effectiveness of Letrozole versus Clomiphene citrate for ovulation induction in polycystic ovarian syndrome (PCOS) with infertility. Methods: This was a prospective randomized trial involving 150 women with PCOS attending the Infertility Clinic at three hospitals in Malaysia. During the initial visit, anthropometric measurements and baseline investigations were performed. Patients were randomized to 5.0 mg Letrozole daily (75 patients) or 100 mg Clomiphene citrate daily (75 patients) from the fifth until the ninth day of menstruation. Serial transvaginal scans were performed to see the dominant follicles, endometrial thickness and number of follicles. Transvaginal scans were performed serially to look for evidence of ovulation. Results: The subjects were homogenously distributed. The difference between Letrozole and Clomiphene citrate for ovulation rate was 59 (78.7%) versus 40 (53.3%). Patients taking Letrozole exhibited a mean endometrial thickness (ET) at mid cycle of menses (Day 11-D14) of 9.2 mm (SD ± 2.3) versus 8.4 mm (SD ± 2.2) for patients taking Clomiphene citrate, and these differences were statistically significant (p < 0.001). In terms of pregnancy rate, Letrozole facilitated pregnancy induction in 19 patients (25.3%) versus 12 patients (16.0%) for Clomiphene citrate; however, this was not statistically significant (p = 0.22). More dominant follicles exhibiting a monofollicular morphology were observed in patients treated with Letrozole compared to patients treated with Clomiphene citrate, with a monofollicular dominant follicle observed in 33 (46.5%) versus 20 (26.7%) patients, respectively. Conclusion: Letrozole provided a more efficient stimulation compared to Clomiphene citrate in terms of ovulation induction, thickening of the endometrial lining and achievement of a successful pregnancy. Clinical Trials. gov Identifier: NCT015-77017.
2009
Background: For more than four decades clomiphene citrate has been the first line of the treatment for ovulatory disorders. The aim of this study was to compare the effects of letrozole and clomiphene citrate on ovulation and pregnancy rate in patients with polycystic ovary syndrome. Methods: In this prospective double-blind study, 100 patients with polycystic ovary syndrome were randomized into two equal groups. The first group received letrozole, 5mg daily (per oral) and the second group received clomiphene, 100mg daily during the 3rd-7th days of the menstrual cycles. Intramuscular human chorionic gonadotropin (hCG) (10,000 IU) was administered to trigger ovulation when at least one mature follicle (≥ 18mm) was developed. Results: Ovulation occurred in 30 patients (60%) of the letrozole group and in 16 patients (32%) of the clomiphene group, which showed a statistically significant difference (P=0.009). The mean number of follicles with diameter >14 mm on the day of administrat...
2009
Background: For more than four decades clomiphene citrate has been the first line of the treatment for ovulatory disorders. The aim of this study was to compare the effects of letrozole and clomiphene citrate on ovulation and pregnancy rate in patients with polycystic ovary syndrome. Methods: In this prospective double-blind study, 100 patients with polycystic ovary syndrome were randomized into two equal groups. The first group received letrozole, 5mg daily (per oral) and the second group received clomiphene, 100mg daily during the 3rd-7th days of the menstrual cycles. Intra-muscular human chorionic gonadotropin (hCG) (10,000 IU) was administered to trigger ovulation when at least one mature follicle (≥ 18mm) was developed. Results: Ovulation occurred in 30 patients (60%) of the letro-zole group and in 16 patients (32%) of the clomiphene group, which showed a statistically significant difference (P=0.009). The mean number of follicles with diameter >14 mm on the day of administr...
Clomiphene Citrate versus Letrozole for Ovulation Induction in PCOS: A Comparative Study
Journal of South Asian Federation of Obstetrics and Gynaecology
Polycystic ovary syndrome (PCOS) affects 20-33% of women of reproductive age and the leading cause of infertility. Treatment includes lifestyle modification, metformin, ovulation induction, surgery, in vitro fertilization. Clomiphene citrate is most commonly used for ovulation induction but is antiestrogenic. Clomiphene resistance occurs in 15-20% of patients. Letrozole, an aromatase inhibitor, inhibits aromatization thus conversion of androstenedione and testosterone to estrogen in the ovary. This releases the hypothalamic/pituitary axis from estrogenic negative feedback, follicle stimulating hormone secretion increases, stimulating ovarian follicular development. We compared clomiphene citrate vs letrozole for ovulation induction in the treatment of anovulatory infertility in women with the polycystic ovarian syndrome. Two hundred consecutive women were observed for a number of cycles required to achieve ovulation, follicular growth, endometrial thickness, dominant follicle size, pregnancy, multiple, and abortion rates. The groups were matched for age, parity, duration of married life, menstrual regularity and prior history of treatment for infertility. Clomiphene showed a significantly increased number of follicles. Monofollicular development and endometrial thickness were higher in the letrozole group. The difference in dominant follicle size, number of cycles to achieve pregnancy or difference in ovulation rate per cycle, number of pregnancies and pregnancy losses per cycle lacked statistical significance. Greater number of follicles in the clomiphene group did not result in increased pregnancy rate. A number of pregnancies were marginally higher but not statistically significant in the letrozole group. There were one quadruplet and one twin gestation in the clomiphene group with none in the letrozole group. This data was not sufficient for statistical analysis. There were no instances of ovarian hyperstimulation syndrome or congenital anomalies in either group.
To evaluate the efficacy of Letrozole in induction of ovulation in cases of CC-resistant PCOS and to compare between Letrozole responders and non-responders. Design: Prospective trial in infertility patients treated with CC Setting: Benha University Hospital Clinic, Egypt. Patient(s): Forty-four infertile women with anovulatory PCOS who failed to ovulate with CC. Intervention(s): Letrozole was given in a dose of 2.5 mg/day from day 3 to day 7 of the menstrual cycle. When the dominant follicle reached a diameter > 18 mm, HCG 10.000 U was given and timed intercourse was advised. Main outcome measure(s): Occurrence of ovulation, endomertial thickness, cervical score & pregnancy rate Results: On the day of HCG administration, the mean number of follicles ≥ 18mm was 1.21, the mean endometrial thickness was 10.2 mm and cervical mucus score was 11.42. Ovulation occurred in 24 cases (54.6%) and pregnancy in 6 cases (25%). There was no significant difference between Letrozole responders and non-responders as regards the age, period of infertility, BMI, waist circumference, LH, FS H or LH/FSH ratio. Conclusion(s): Induction of ovulation with Letrozole in CC-resistant PCOS is not dependent on age, period of infertility, BMI, waist circumference, menstrual pattern, hirsutism, LH, FSH or LH/FSH ratio. Further studies are necessary to confirm these results.
Fertility and Sterility, 2010
Objective: To compare the effect of letrozole with combined metformin and clomiphene citrate (CC) for ovulation induction in CC-resistant women with polycystic ovary syndrome (PCOS). Design: A randomized controlled trial. Setting: University teaching hospital and a private practice setting. Patient(s): Two hundred fifty anovulatory women (582 cycles) with CC-resistant PCOS. Intervention(s): Patients received 2.5 mg of letrozole daily (123 patients, 285 cycles) or combined metformin-CC (127 patients, 297 cycles) for three treatment cycles. Main Outcome Measure(s): Ovulation rate, number of follicles, serum E 2 , serum P, endometrial thickness, pregnancy, and miscarriage rates. Result(s): Ovulation occurred in 185/285 cycles (64.9%) in the letrozole group versus 207/297 cycles (69.6%) in the combined metformin-CC group, without statistically significant difference. The total number of follicles was significantly more in the combined metformin-CC group (4.4 AE 0.4 vs. 6.8 AE 0.3). A nonsignificant increase in endometrial thickness on the day of hCG administration was observed in the letrozole group (9.5 AE 0.2 mm vs. 9.1 AE 0.1 mm). No statistically significant difference regarding the pregnancy rate (PR) was observed between both groups (14.7% vs. 14.4%). Conclusion(s): Letrozole and combined metformin-CC are equally effective for inducing ovulation and achieving pregnancy in patients with CC-resistant PCOS.