A Comparative Study Of Efficacy Of Letrozole Versus Clomiphene Citrate In Ovulation Induction In Patients With Polycystic Ovarian Syndrome

Abstract

Background:  Infertility affects approximately 10-15% of couples . The prevalence of Polycystic ovarian syndrome (PCOS) in India is found to be 5 to 10 %. PCOS is an endocrine disorder characterised by oligo-anovulation, hyperandrogenism and polycystic ovaries , often associated with infertility due to anovulation .This study was conducted to evaluate the efficacy of letrozole (LTZ) as an ovulation inducing agent and to compare it with clomiphene citrate (CC) in infertile women with PCOS.

Methods : This is a comparative study.  This study includes 120 women referred to obstetrics & gynecology OPD of Sri Venkateshwaraa Medical college Hospital and Research centre, Puducherry, with infertility due to anovulation. The patients were divided in two groups each comprised of 60 patients. In Group-A, 60 women were given LTZ, 5mg from day 3 to day 7 of menstrual cycle. In Group-B, 60 women were given CC, 100mg from day 3 to day 7 of menstrual cycle. Follicular monitoring was done by Transvaginal ultrasonography(TVS)  on days 10, 12, 14, 16 of the cycle till a mature follicle of size 18mm or more (by averaging inner two diameters of the follicle)was detected. A single injection of hCG 10,000 IU IM was given if at least one follicle was >18 mm and the endometrial thickness at least more than 8 mm was noted.

Results: Mean age, parity, and the duration of infertility were similar in both groups. Ovulation rate was 71.7% in letrozole group and 66.7% in clomiphene citrate group (p=0.553). Monofollicular development was significantly more common in the Letrozole group (46.7%) compared to the Clomiphene Citrate group (23.3%), with a significant chi-square test (p = 0.007) and Multifollicular development was significantly more frequent in the Clomiphene Citrate group (53.3%) compared to the Letrozole group (20.0%), with a highly significant p-value (p = 0.0001). A significant difference in endometrial thickness was observed, with the Letrozole group showing a mean thickness of 9.21 ± 0.84 mm compared to 8.01 ± 0.78 mm in the Clomiphene Citrate group (p = 0.0001).

Conclusion : In conclusion, this study highlights the superior efficacy of Letrozole compared to Clomiphene Citrate in inducing ovulation among patients with Polycystic Ovary Syndrome (PCOS). Letrozole demonstrated advantages in promoting endometrial thickness, achieving a more favorable hormonal profile, and reducing the incidence of multifollicular development. While both medications exhibited comparable rates of ovulation and pregnancy, the distinct benefits of Letrozole suggest its potential as a preferred option in fertility treatment for PCOS patients, emphasizing the importance of personalized approaches in optimizing reproductive outcomes.