COMPARATIVE EFFECTIVENESS OF LETROZOLE VERSUS CLOMIPHENE CITRATE FOR OVULATION INDUCTION IN WOMEN WITH POLYCYSTIC OVARY SYNDROME

Abstract

Background: Polycystic ovary syndrome (PCOS) is a common cause of anovulatory infertility in women of reproductive age.

Objective: To compare the effectiveness of letrozole versus clomiphene citrate in inducing ovulation in women with PCOS.

Methodology: This prospective comparative study was conducted at the Department of Gynecology and Obstetrics, Liaqat Memorial Hospital Kohat, from January 2021 to December 2021. A total of 130 Rotterdam-diagnosed PCOS women aged 18–35 were randomly randomized to either letrozole (n=65) or clomiphene citrate (n=65). We gave 2.5–5 mg/day letrozole and 50–100 mg/day clomiphene citrate from day 3 to day 7 of the menstrual cycle. Transvaginal ultrasound and mid-luteal progesterone levels confirmed ovulation. Also documented were endometrial thickness, prominent follicles, pregnancy outcomes, and side effects. Data were evaluated using SPSS 25 and p<0.05 was deemed significant.

Results: In the letrozole group, 54 patients (83.08%) ovulated, compared to 46 patients (70.77%) in the clomiphene group. Letrozole treatment resulted in a higher mean number of dominant follicles, improved mid-luteal progesterone, and greater endometrial thickness compared to clomiphene. Clinical pregnancy occurred in 20 patients (30.77%) receiving letrozole and 14 patients (21.54%) receiving clomiphene. Multiple pregnancies were 3.08% vs 4.62%, and miscarriage rates were 4.62% vs 6.15%, respectively. Adverse effects were mild, with endometrial thinning significantly lower in the letrozole group (4.62% vs 16.92%).

Conclusion: Letrozole is more effective than clomiphene in inducing ovulation with favorable endometrial outcomes and a safe side effect profile in women with PCOS.