Comparative study of the efficacy of combined metformin–clomiphene citrate versus combined metformin–letrozole in induction of ovulation in overweight women with polycystic ovarian syndrome

Abstract

Background Polycystic ovary syndrome (PCOS) is the common cause of infertility. Clomiphene citrate (CC) is the first-line treatment in ovulation induction. Metformin biguanide has been used in insulin resistance in PCOS women. Adding metformin to CC in the CC-resistant PCOS was highly effective in achieving ovulation in 68.6–77.7% of patients. Letrozole, aromatase inhibitor, its use in patients with CC-resistant PCOS achieved ovulation 54.6–84.4% of the time. Aim We aimed to compare the efficacy of combined metformin–CC to combined metformin–letrozole in ovulation induction in overweight infertile PCOS women. Patients and methods A prospective randomized study was conducted at Obstetrics & Gynecology Department in Tanta University Hospitals. In total, 40 infertile overweight cases with PCO were included. Cases were randomly allocated in two groups. Results The mean age was 26.40 ± 5.20 years for CC group and 26.50 ± 5.10 years for letrozole group. BMI was 27.50 ± 1.43 for CC group and 27.45 ± 1.36 for letrozole group. The duration of infertility was 2.90 ± 1.40 years for CC group and 2.88 ± 1.21 for letrozole group. There was insignificant difference in both groups as regards the follicles more than 18 mm and endometrial thickness. But, as regards progesterone level, there was a statistically significant increase in letrozole group than CC group (P<0.005). Concerning pregnancy rate, there was insignificant difference between two groups. Conclusion The present investigation demonstrated that both CC and letrozole are similarly viable in treatment of infertility in PCOS patients, when joined with metformin treatment.