Comparison between The Efficacy of Combined Metformin – Letrazole with Metformin – Clomiphene Citrate in Polycystic Ovarian Syndrome


background: Adding Metformin to clomiphene citrate in clomiphene –resistant PCOS patients increases ovulatory response. However because of anti-estrogenic effects of clomiphene it may be associated with lower pregnancy rate. Offsetting the ovulation rate benefit, Letrazole is an aromatase inhibitor which induce ovulation without antiestogenic effects.Aim of Study: is to induce ovulation& increase the pregnancy rate and live birth rate in patient with PCOS using a new era of therapy with less side effects, less complications and better patient compliance.Materials and Methods: The study is a single – blind randomized clinical trial , 120 ovarian cycle were studied in 60 clomiphene – resistant patients with PCOS , who were chosen among 115 PCOS patients attending infertility clinic in Samawa city – Iraq during the years 2011 – 2012 Infertile women with PCOS were randomly divided into Metformin –Letrazole (29 patients) and Metformin – clomiphene groups (30 patients) after an initial 6 – 8 weeks of metformin.They received either Letrazole (5mg) from2nd to 7th day orclomiphene citrate (100mg)daily from 5th to 9th day of menstrualcycle . Estradiol (E2) level , number of follicles and endometrial thickness were measured on the day of HCG administration .The pregnancy rate of both groups also estimated.Results: Mean total E2 and E2per mature follicle were significantly higher in clomiphene group without a difference in mean number of follicles ≥ 18mm and ovulation rate .Endometrialthickness was significantly higher in Letrazole group .Thepregnancy rate in Letrazole group (10 patients, 34.50%) as compared with clomiphene group (5 patients 16.6%) did not show significant difference, whereas full – termpregnancies were higher in Letrazole group (10 patients 34.5%) versus 3 patients (10%).Conclusion: In clomiphene resistant PCOS, the combination of Letrazole and Metformin leads to higher full term pregnanciesas compared with clomiphene and Metformin .