Efficacy of combined metformin- letrozole in comparison with metformin-laparoscopic ovarian diathermy in ovulation induction and reproductive outcome for women with clomiphene citrate resistant polycystic ovary syndrome

Abstract

Background and objective: polycystic ovary syndrome(PCOS) is a common cause of infertility and is associated with chronic anovulation and hyperandrogenism.The aim of current study is to compare the effect of combined letrozole metformine to that of metformin-laparoscopic ovarian drilling (LOD) for ovulation induction in patients with PCOS.Materials and Methods: on the whole 138 ovarian cycles were studied in 60 patients with clomiphene citrate resistant PCOS in AL-Diwaniyah Maternity and Pediatrics Teaching Hospital during the period of June 2112-June 2114. All patients (n=60) received metformin 500mg /3times per day ,group A(n=30)received letrozole 5mg daily for 5 days repeated for 6 cycles, group B(n=30) underwent LOD and followed for six cycles. Outcome measures were ovulation rates, endometrialthickness, pregnancyrates, live birth rates and miscarriage rate.Results: ovulation rate was higher in group A than group B(63.33% versus 30.0%),a significant increase in endometrial thickness in group A than group B(9.9mm versus 9.03 mm).Live birth rate was higher in group A 83.33% compared to 33.33% in group B. There were no significant differences regarding miscarriage rates between both groups. No multiple pregnancy or ovarian hyper stimulation syndrome or congenital abnormality among live births were reported.Conclusions: Combinedletrozolemetformin seems to be a suitable second line ovulation inducing alternative to LOD in women with PCOS who do not respondwith clomiphene citrate.