Comparison between The Efficacy of Combined Metformin – Letrazole with Metformin – Clomiphene Citrate in Polycystic Ovarian Syndrome
Kerbala Journal of Medicine,
Volume 9, Issue 2, Pages 2462-2469
Abstractbackground: 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 .
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