Efficacy Of Letrozole Research Articles

Efficacy analysis of letrozole combined with gonadotropin-releasing hormone antagonists in patients with high risk of ovarian hyperstimulation syndrome undergoing total embryo freezing

Objective: To investigate the clinical efficacy of letrozole combined with gonadotropin-releasing hormone antagonists (GnRH-ant) in patients at high risk of ovarian hyperstimulation syndrome (OHSS) who underwent total embryo freezing after oocyte retrieval. Methods: A retrospective analysis was conducted on 348 female patients who underwent in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) at the Reproductive and Genetic Hospital of the First Affiliated Hospital of Zhengzhou University between January and July 2023. Due to their high risk of OHSS, these patients canceled fresh embryo transfer and opted for total embryo freezing. Based on patients' preferences, those who received GnRH-ant and letrozole after oocyte retrieval were categorized as the intervention group (164 cases), while those who did not receive these medications were categorized as the control group (184 cases). The first luteal phase after oocyte retrieval, OHSS grading, ovarian volume, and estradiol (E2) levels were evaluated in both groups. A multivariate logistic regression model was used to analyze factors related to moderate-to-severe OHSS among patients at high risk of OHSS who underwent total embryo freezing after oocyte retrieval. Results: The age of the intervention and control groups was (29.3±3.8) and (29.4±4.1) years, respectively (P=0.821). The duration of the first luteal phase post-oocyte retrieval was shorter in the intervention group [(7.16±1.39) days] compared to that in the control group [(13.88±2.11) days] (P<0.001). The incidences of mild, moderate, and severe OHSS in the intervention group were 75.0% (123 cases), 23.8% (39 cases), and 1.2% (2 cases), respectively, whereas in the control group they were 12.5% (23 cases), 60.9% (112 cases), and 26.6% (49 cases) (P<0.001). E2 levels on the 2nd and 6th days after oocyte retrieval [M(Q1,Q3)] in the intervention group were 1 520.0 (1 213.8, 1 884.8) and 108.5 (45.6, 218.0) ng/L, respectively, which were statistically significantly lower than those in the control group [1 666.0 (508.8, 1 702.0) ng/L] and [1 761.0 (826.0, 2 546.5) ng/L] (P<0.001). The abdominal cavity effusion in the intervention group [M(Q1,Q3)] were 19.5 (0, 30) and 0 mm, statistically significantly less than those in the control group [46.0 (0, 61.0) mm] and [54.5 (0, 69.5) mm] (P<0.001). On the 6th day after oocyte retrieval, the bilateral ovarian volumes in the intervention group were smaller than those in the control group (P<0.001). Multivariate logistic regression analysis indicated that no combined treatment with letrozole and GnRH-ant was a risk factor of moderate to severe OHSS. The risk of developing moderate to severe OHSS in the control group was 35.312 times higher than that in the intervention group (OR=35.312, 95%CI: 17.488-71.300). Conclusions: The administration of letrozole combined with GnRH-ant post-oocyte retrieval in patients at high risk of OHSS can prevent the occurrence of moderate-to-severe OHSS, shorten the first luteal phase, accelerate the reduction of serum E2 levels, and promote the recovery of ovarian volume and absorption of abdominal fluid.

Strong Early Impact of Letrozole on Ovulation Induction Outperforms Clomiphene Citrate in Polycystic Ovary Syndrome.

Polycystic ovary syndrome is a common endocrine disorder, characterized by hyperandrogenism and/or chronic oligo/anovulation, which leads to infertility. The aim of this systematic review and meta-analysis was to explore the efficacy of letrozole compared with clomiphene citrate for ovulation induction in women with polycystic ovarian syndrome. The study protocol has been registered with PROSPERO (registration number CRD42022376611). The literature search included randomized clinical trials. We conducted our systematic literature search across three medical databases: MEDLINE (via PubMed), Cochrane Library (CENTRAL), and Embase. The data synthesis employed a random effects model. Out of the 1994 articles screened, 25 studies fulfilled the inclusion criteria. The letrozole group exhibited a significant increase in endometrial thickness (mean difference = 1.70, confidence interval: 0.55-2.86; I2 = 97%, p-value = 0.008). The odds of ovulation (odds ratio = 1.8, confidence interval: 1.21-2.69; I2 = 51%, p-value = 0.010) and pregnancy (odds ratio = 1.96, confidence interval: 1.37-2.81; I2 = 32%, p-value = 0.002) were significantly higher. The resistance index of the subendometrial arteries showed a significant decrease (mean difference = -0.15, confidence interval: -0.27 to -0.04; I2 = 92%, p-value = 0.030). Women diagnosed with polycystic ovarian syndrome and treated with letrozole for ovulation induction had increased ovulation and pregnancy rates and increased endometrial thickness. The lower resistance index of subendometrial arteries can enhance intrauterine circulation, creating more favorable conditions for embryo implantation and development.

Feasibility and efficacy of Letrozole in heavily pre-treated patients with relapsed ovarian cancer not eligible for further chemotherapy cycles

Feasibility and efficacy of Letrozole in heavily pre-treated patients with relapsed ovarian cancer not eligible for further chemotherapy cycles

Efficacy of Letrozole vs Clomiphene Citrate for induction of ovulation in women with polycystic ovarian syndrome.

To compare the efficacy of letrozole vs Clomiphene citrate for ovulation induction in PCOS women. This double blind randomized controlled trial was conducted at Services Hospital, Lahore, from January 2016 to December 2020. Total 220 patients, diagnosed with PCOS according to Rotterdam criteria were randomly assigned into two groups after taking informed consent. The women were followed for ovulation, pregnancy and live birth rates in the next five consecutive menstrual cycles with either clomiphene citrate or letrozole. Letrozole had significantly better pregnancy rate (29.0% vs 15.4% p-value 0.015), monofollicular development (77.2% vs 52.7% p-value 0.000) and live birth rate (25.4% vs 10.9% p-value 0.005) as compared to clomiphene citrate. There was no difference between the two groups in ovulation rate (68.1% vs 63.6%, p-value 0.477), early pregnancy loss (3.6% vs 4.5% p-value 0.734), and twin pregnancy (0.0% vs 1.81% p-value 0.155). There was no ectopic pregnancy and no congenital anomalies in both groups. Hot flushes were higher in clomiphene group (31.8% vs 12.7% p-value 0.001) while fatigue (30.9% vs 8.1% p-value 0.000) and dizziness (21.8% vs 10.0% p-value 0.029) was higher with letrozole but these were well tolerated. Letrozole is better treatment choice than clomiphene citrate in PCOS women with infertility in terms of pregnancy and live birth rate.ClinicalTrials.gov Identifier: NCT05702957.

A phase II trial of palbociclib combined to letrozole after progression on second-line chemotherapy for women with ER/PR-positive high-grade serous or endometrioid ovarian, fallopian tube, or peritoneal cancer: LACOG 1018.

5514 Background: Treatment options for patients with high-grade ovarian serous (HGSC) or endometrioid carcinoma (HGEC) who progress after receiving chemotherapy for recurrence are limited. Methods: LACOG 1018, a phase II, single-arm, multicenter trial evaluated the efficacy of letrozole 2.5mg/day po continuously plus palbociclib 125mg/day po for 21 days in 28-day cycles in patients with histologically proven ovarian HGSC or HGEC, fallopian tube or peritoneal cancer who had progressed on prior chemotherapy for locoregional recurrence or metastatic disease (at least one platinum-based regimen). Patients had centrally confirmed ER and/or PR positivity (&gt; 10% by immunohistochemistry) and ECOG PS 0-2. The primary endpoint was progression-free survival (PFS) at 12 weeks by RECIST 1.1. Secondary endpoints were overall survival (OS), overall response rate (ORR), clinical benefit rate (CBR) and safety. Tumor evaluations were performed every 6 weeks until week 24. Sample size was calculated as 31 patients for the primary endpoint (90% power to detect a two-sided significance level of 5%, 45% PFS at 12 weeks) and 39 patients for secondary endpoints considering 10% drop-out. NCT03936270. Results: A total of 41 eligible patients were included in five Brazilian centers between Feb2020-Jan2022 (table). The PFS-week12 rate was 63.4% (95%CI 46.8 – 76.1). At the time of analysis (cut-off date Jan 18th, 2023) median follow-up was 18.1 months (95%CI 12.9 – 24.3), and 37 PFS events had occurred. Median PFS was 4.2 months (95%CI 2.7 – 5.5) and median OS was 13.4 months (95%CI 10.4 – 20.1). The ORR was 7.7% (N=3 PR) and the CBR was 71.8%. Treatment-related adverse event rates of any grade and grade 3-4 were 95.1 % and 51.2 %, respectively. Grade 3-4 neutropenia was reported in 17 (41.5%) patients, and febrile neutropenia in 1 (2.4%). Only one patient (2.4 %) discontinued the treatment due to toxicity. At the cut-off date, three patients remained on treatment. Conclusions: Palbociclib combined to letrozole demonstrated a significant efficacy in terms of PFS rate at 12 weeks (63.4%) and CBR (71.8%), with no new safety concerns in women with recurrent advanced and metastatic hormone receptor-positive ovarian cancer. These results warrant further investigation of palbociclib plus letrozole in high-grade ovarian cancer. Clinical trial information: NCT03936270 . [Table: see text]

Comparison of letrozole with gonadotropins and letrozole_gonadotropin combination for ovulation induction in PCOS women after clomiphene citrate failure

The aim of this study is to compare the efficacy of letrozole with gonadotropin and letrozole plus gonadotropin for ovulation induction in PCOS women after clomiphene citrate failure, Seventy eight women with PCO failed to conceive with clomiphene citrate divided in to three groups A,B,C treated with letrozole tablet, , letrozole plus follicular stimulating hormone and follicular stimulating hormone injection alone respectively for ovulation induction..Results: ovulation rate was (65.4%),(76.9%) and(76.9%) in group A,B &amp;C respectively, pregnancy rate in study groups were (50%),(69.2%)and(65.4%) in A,B,&amp;C respectivelyConclusion: Letrozole appears to be a suitable ovulation inducing agent in PCOS women with CC failure and significant higher pregnancy rate was observed in letrozole co treatment with gonadotropins as compared to other two protocoles

The Case of an Endometrial Cancer Patient with Breast Cancer Who Has Achieved Long-Term Survival via Letrozole Monotherapy

Herein, we present the successful treatment of a 92-year-old woman who experienced recurrent EC in the vaginal stump and para-aortic lymph nodes. The patient was first treated with paclitaxel and carboplatin for recurrent EC, which was abandoned after two cycles of chemotherapy because of G4 hematologic toxicity. Later, the patient was treated with letrozole for early-stage breast cancer, which was diagnosed simultaneously with EC recurrence. After four months of hormonal therapy, a partial response was observed not only in the lesions in the breast, but also those in the vaginal stump and para-aortic lymph nodes. She had no recurrence of breast cancer or EC, even after six years of treatment with letrozole-based hormonal therapy. Subsequent whole-exome sequencing using the genomic DNA isolated from the surgical specimen in the uterine tumor identified several genetic variants, including actionable mutations, such as CTNNB1 (p.S37F), PIK3R1 (p.M582Is_10), and TP53 c.375 + 5G>T. These data suggest that the efficacy of letrozole is mediated by blocking the mammalian target of the rapamycin pathway. The findings of this study, substantiated via genetic analysis, suggest the possibility of long-term disease-free survival, even in elderly patients with recurrent EC, which was thought to be difficult to cure completely.

Therapeutic impact of letrozole and clomiphene citrate for ovulation induction in Iraqi female patients with polycystic ovary syndrome

Introduction: Clomiphene citrate (CC) is the most commonly used ovulation induction agent in women with polycystic ovary syndrome (PCOS). Letrozole has attracted attention for its ovulation induction effects as a safe, potentially better alternative to CC. The aim of this study was to compare the therapeutic efficacy of letrozole in comparison to CC for ovulation induction in female patients with PCOS in Baghdad Province, Iraq. Materials and Methods: A prospective, randomized, controlled study was carried out on 166 female patients diagnosed with anovulatory infertility due to PCOS and randomly assigned into two groups. Group A included ninety-four participants who received CC. Group B included 85 participants who received letrozole. The main outcomes were the ovulation induction and therapeutic outcomes of CC and letrozole, including endometrial thickness, number of mature follicles, pregnancy rate, number of stimulated cycles and mono-ovulation rate. Results: Endometrial thickness improved significantly more with CC than with letrozole (8.08 ± 1.28 vs. 7.66 ± 1.41; P = 0.05), as did the number of mature follicles (3.07 ± 1.23 vs. 1.97 ± 0.83; P = 0.0001). Nevertheless, Group B patients reported a higher significant rate compared to Group A regarding pregnancy rate (62% vs. 38%; P &lt; 0.01), number of stimulated cycles (91% vs. 78%; P &lt; 0.05), and mono-ovulation rate (29% vs. 5.75%; P = 0.0001). Conclusion: Letrozole is preferable to CC in terms of a higher pregnancy rate as well as mono-follicles' ability to decrease the risk of multiple pregnancies, which is clearly observed with CC. The higher success of letrozole over CC is thought to be related to the higher ovulation rate per cycle. The following core competencies are addressed in this article: Patient care and procedural skills, medical knowledge.

The future of frozen-thawed embryo transfer in hormone replacement therapy cycles.

This review focuses on the efficacy of letrozole stimulated frozen-thawed embryo transfer (FET) compared to hormone replacement therapy (HRT) FET in women with polycystic ovarian syndrome (PCOS) and/or oligo-anovulation. Further, obstetric and perinatal risks in HRT FET are summarized. The presence of a corpus luteum seems to reduce the risk of pregnancy-related hypertension and preeclampsia after FET. As a natural cycle (NC) FET is not an option for women with oligo-/amenorrhea these women may benefit from FET with mild stimulation compared to HRT FET. The intention of mild stimulation in anovulatory women is to induce (mono) ovulation to mimic the endocrine profiles of the natural cycle and the early pregnancy after natural conception. Mild stimulation by letrozole is patient friendly and cheap compared to gonadotropin stimulated FET and has been increasingly used in recent years. Although the quality of evidence is low, the pregnancy outcomes after letrozole FET seems similar or even better compared to HRT FET in women with PCOS and/or oligo-anovulation. Natural and modified NC FET should be used whenever possible to mitigate adverse obstetric and perinatal outcomes after HRT FET. For anovulatory women, whenever ovulation can be induced, we advocate the use of mild stimulation FET to create a corpus luteum awaiting results from RCTs limited to oligo-anovulatory women.

Comparison of the Efficacy of Letrozole and Clomiphene Citrate in women having Anovulatory Infertility

Aim: To compare the efficacy of letrozole and clomiphene citrate in women having anovulatory infertility. Study design: Randomized Controlled Trial. Place and duration of study: 16th October 2020 to 15th September 2021 in Department of Obstetrics &amp; Gynecology, Shahida Islam Medical Complex Lodhran. Methods: In our study 112 patients between ages 18 to 40 years with anovulation were included. Patients having H/O previous pelvic surgery, raised prolactin and TSH levels were excluded. These women were divided into02 groups i.e. Group A (clomiphene citrate) &amp; Group B (letrozole), by lottery method and the effectiveness was noted in both groups. Results: Mean age of women in group A was 24.53±6.12 years and in group B was 25.37±6.33 years. Majority women included in our study, 78(69.64%) were between ages 18 to 30 years. Duration of infertility was 3.28±2.11 years. Mean infertility duration in group A was 3.63±2.10 years and in group B was 3.79±2.14 years. The efficacy of drug shownin Group A was 9(8.03%) while in Group B was 18(16.07%) (p-value = 0.005). Conclusion: We concluded from this study that letrozole is proved to be more efficacious than clomiphene citrate in anovulatory infertility. Keywords: Anovulation, Infertility, Letrozole, Clomiphene Citrate, Conception Rate

Clinical Efficacy and Analysis of Letrozole Combined with Li Shenbao Treatment in Ovarian Hyporesponsiveness

We attempt to investigate and study the clinical efficacy of letrozole combined with Li Shenbao treatment in patients with ovarian hyporesponsiveness and improve the clinical treatment effect of patients. We selected 153 patients with ovarian hyporesponsiveness in a hospital from January 2018 to December 2020 as the study objects and divided them into 2 groups according to when they enter the in vitro fertilization assisted pregnancy cycle. Control group consists of 76 patients treated with antagonist protocol, while observation group consists of 77 patients treated with letrozole combined with Li Shenbao treatment. The clinical outcomes of the patients with low ovarian hyporesponsiveness were assessed and compared. The results showed that observation group possessed higher M II egg rate, high-quality embryo rate and clinical pregnancy rate than control group (p<0.05). Observation group possessed lower miscarriage rate than control group (p<0.05). The clinical efficacy of Li Shenbao combined with letrozole in patients with ovarian hyporesponsiveness is of good value. This treatment regimen can better improve the ovulation promotion outcome, and to a certain extent, increase the clinical pregnancy rate and reduce the miscarriage rate, and this combination treatment plan has good application prospects.

Comparison of letrozole and clomiphene citrate efficacy in terms of ovulation induction and pregnancy rate.

Objective: To compare the efficacy of Letrozole and clomiphene citrate in Patients of Anovulation polycystic ovarian syndrome with Infertility. Study Design: Randomized Controlled Trial Setting: Department of Obstetrics and Gynecology Independent Medical College Faisalabad. Period: 30-09-2019 to 29-6-2020. Material &amp; Methods: This study included 100 patients with 50 patients in each group. Group A received 2.5 to 5mg letrozole in each cycle from day 3 to 7. Group B received clomiphene citrate 50 to 100 mg incremental dose depending on ovarian response. Both Drugs were given for consecutive 3 to 6 cycles to see response. Main outcome Measure included optimal follicle size (&gt; 18mm), endometrial thickness, and pregnancy rate. Epidemiological data and efficacy outcome measures were recorded on a Performa. Statistical analysis was done using SPSS version 13. Chi-square test applied and p-value &lt;o.o5 was considered significant. Both group included primary infertility patients. Results: The mean age of patients was 28.03+ 3.02 years. Mean age of group A patients was 29.04+3.44 and 28.47+3.90 group B patients. Mono ovulation in group A patients (88.9%) and 27 in group b patients (60.0%). The mean endometrial thickness was 9.6mm + 1.6 in letrozole group and 6.9mm + 1.2 in clomiphene citrate group A. In group A 18% got pregnant from Letrozole group and 1.1% from the group B. Conclusion: Efficacy was significantly higher in group A Patients received letrozole as compared to patients echo received clomiphene citrate. The effects of Letrozole showed better outcome in terms of Ovulation Induction Endometrial Thickness and Pregnancy rate.

Retracted: Efficacy of Letrozole Combined with Urinary Gonadotropin for Ovulation Induction in Endocrine Abnormal Infertility Patients: A Retrospective Single-Center, Case-Control Study.

[This retracts the article DOI: 10.1155/2022/5363754.].

Exploring the Dosage of Asari Radix et Rhizoma in Traditional Chinese Medicine and its Application in Rheumatoid Arthritis

We attempt to investigate and study the clinical efficacy of letrozole combined with Li Shenbao treatment in patients with ovarian hyporesponsiveness and improve the clinical treatment effect of patients. We selected 153 patients with ovarian hyporesponsiveness in a hospital from January 2018 to December 2020 as the study objects and divided them into 2 groups according to when they enter the in vitro fertilization assisted pregnancy cycle. Control group consists of 76 patients treated with antagonist protocol, while observation group consists of 77 patients treated with letrozole combined with Li Shenbao treatment. The clinical outcomes of the patients with low ovarian hyporesponsiveness were assessed and compared. The results showed that observation group possessed higher M II egg rate, high-quality embryo rate and clinical pregnancy rate than control group (p<0.05). Observation group possessed lower miscarriage rate than control group (p<0.05). The clinical efficacy of Li Shenbao combined with letrozole in patients with ovarian hyporesponsiveness is of good value. This treatment regimen can better improve the ovulation promotion outcome, and to a certain extent, increase the clinical pregnancy rate and reduce the miscarriage rate, and this combination treatment plan has good application prospects.

The Efficacy of Letrozole with or without Gonadotropins on Pregnancy Rates after Intrauterine Insemination in Women with Polycystic Ovarian Syndrome: A Randomized Clinical Trial

Patients were randomized into two groups; the letrozole alone (A) and the letrozole with gonadotropin (B) groups. The mean age for both groups was 27.3 (± 3.6) and 25 (± 3), respectively. The total pregnancy rate was 31.1% with no statistical significance (P = 0.788) between group A (17.8%) and B (20%). Additionally, the mean number of follicles was significantly higher (P < 0.001) in the B [2.82 (± 0.89)] than A [1.89 (± 0.71)] groups. We also found no significance regarding the endometrial thickness and estradiol levels between the two groups (P = 0.303 and 0.496, respectively).

Comparison of The Efficacy of Letrozole Versus Danazol in Pain Relief in Endometriosis

Endometriosis is a chronic inflammatory disease defined as the presence of endometrium-like tissue outside the uterus which is responsive to the estrogen levels in blood circulation. Objective: To compare the efficacy of letrozole versus danazol in pain relief in endometriosis. Methods: This randomized controlled trial was conducted at the department of Obstetrics &amp; Gynecology, Ayub Teaching Hospital, Abbottabad, Pakistan from January 2018 to December 2021. Patients diagnosed with endometriosis were enrolled and detailed medical history was taken. Patients were randomly divided into either Letrozole (n=120) or Danazol (n=120) group. Both treatment groups were evaluated after 3 months of treatment and efficacy was compared in terms of pain relief in patients of endometriosis. Results: In a total of 240 patients, the mean age was 28.30±4.76 years. The mean endometrial cyst size was 2.48±1.14 cm. At baseline, mean visual analog scale (VAS) score was recorded as 5.46±1.09 points in letrozole group and 5.28±1.01 points in danazol group (p=0.186). After three months of treatment, the mean VAS score was 2.94±1.96 points in letrozole group and 3.99±1.90 points in danazol group (p=0.002). Relief of symptoms was observed in 114 (47.5%) women and more patients reported relief of symptoms in letrozole group (65 patients) than the danazol group (49 patients) (p=0.039). Conclusion: Letrozole was more effective as compare to danazol in relief of pain in patients with endometriosis

Efficacy of Letrozole Combined with Urinary Gonadotropin for Ovulation Induction in Endocrine Abnormal Infertility Patients: A Retrospective Single-Center, Case-Control Study.

Aims To ask lots of questions and try to find the truth about the medicine-based effectiveness of letrozole (LE) combined with human menopausal gonadotropin (HMG) in the treatment of inability to have children crops patients with endocrine (things that are different from what is usually expected and the effect on ovulation-related chemicals produced by the body). Materials and Methods A total of 160 unable to have children crops patients with endocrine things that are different from what is usually expected who were treated in our hospital from March 2019 to March 2022 were selected as the subjects of this look at how things were in the past study and were divided into instance of watching, making a statement group was treated with human menopausal gonadotropin on the basis of the control group. The differences in serum related to the process of making children, chemical produced by the body levels, ovarian function, and ovulation induction effect between the two groups were watched and compared. Results After treatment, LH, FSH, PRL, and E2 in the observation group were better than those in the control group. The ovarian volume, follicle size, follicle diameter, and endometrial thickness of the two groups of patients were significantly improved, and the observation group was better than the control group. Significance is P < 0.05. After treatment, the ovarian volume, follicle size, follicle diameter, and endometrial thickness in the two groups were significantly improved, and the observation group was better than the control group, and the difference was statistically significant (P < 0.05). The ovulation rate, pregnancy rate, singleton pregnancy rate, and multiple pregnancy rate of the observation group were higher than those of the control group, and the difference was statistically significant by the chi-square test (P < 0.05). Conclusion Letrozole can promote the improvement of sex hormones in infertile patients. After being combined with human menopausal gonadotropin treatment, the follicle development and ovulation of patients are significantly improved, and infertility is improved to a certain extent. It has a certain reference value in the clinical treatment of endocrine abnormal infertility.

P-596 Comparative efficacy of Letrozole (5 mg) versus Clomiphene citrate (100 mg) for ovulation induction among infertile women

Abstract Study question Does Letrozole have better offerings while being compared to Clomiphene citrate as an Ovulation inducing agent in infertile women? Summary answer Compared to clomiphene, Letrozole - an aromatase inhibitor, is associated with higher live-birth and ovulation rates among infertile women. What is known already Anovulatory dysfunction is a common problem and is responsible for about 40% of female infertility and among causes; PCOS (polycystic ovarian syndrome) is the leading cause. Clomiphene citrate has been traditionally used as the drug of choice for treatment of women with anovulatory infertility. In the last decade, an aromatase inhibitor, letrozole, has emerged as an alternative ovulation induction agent among anovulatory women with polycystic ovarian syndrome. Letrozole has a definitive role in anovulatory women who have not responded to clomiphene citrate therapy, as confirmed by literature. Study design, size, duration Randomized double-blind study. Total 100 women were randomly assigned and divided into 2 groups of 50 patients each. The 2 groups were well matched at baseline. Study participants are of age 20 to 39 years. Study began in October 2019 and was completed in October 2021. Participants/materials, setting, methods Group 1: Clomiphene citrate (100 mg daily) and group 2: letrozole (5 mg daily), started from any day between 3-5 of the menstrual cycle and continued up to 5 consecutive days. Both groups have received Estradiol Valerate 4 mg on the 12th day of menstruation until 16th day of menstruation. All patients had USG monitoring of follicular and endometrium size with perifollicular flow and uterine scoring system for reproduction (USSR) score with timed intercourse. Main results and the role of chance Women who received letrozole as compared to those who received clomiphene citrate had more cumulative live births (36 of 50 [72%] vs. 28 of 50 [56%]). Number of women ovulated in Letrozole group was – 42 (84%) while in Clomiphene citrate (CC) Group it was 39 (78%). The ovulation rate was significantly higher with letrozole than with clomiphene citrate. Among the study participants who ovulated, there was a significantly greater chance of singleton pregnancy with letrozole compared to clomiphene citrate. The mean number of dominant follicles (18 mm) was 1.40 ± 0.58 for letrozole and 1.10 ± 0.86 for clomiphene citrate (P-value = &amp;lt;0.05). The size of follicular development by day 14 was 17.6 ± 2.92 mm in Letrozole group while in Clomiphene citrate group it was 15.8 ± 3.84 mm (P-value = &amp;lt;0.05). The mean endometrial thickness by day 14 was 7.2 ± 0.77 mm for Letrozole and 6.8 ± 0.92 mm for clomiphene citrate (P-value = &amp;lt;0.05). Limitations, reasons for caution In our study, we have not considered lifestyle intervention before enrolment; although such interventions are recommended by experts, but there is currently no evidence from high quality clinical trials that they improve pregnancy outcomes in obese women. Wider implications of the findings Although Letrozole has still not gained universal acceptance as an ovulating agent for a variety of reasons, emerging evidences suggests that Letrozole could be an effective option and is non inferior to clomiphene citrate as an ovulating agent especially, in patients with non- responders to Clomiphene citrate and PCOS women. Trial registration number Not applicable

Unexplained Infertility: Comparison of Efficacy of Letrozole and Clomiphene Citrate

Background: Infertility is always been considered as social issue because of its impact on individuals as well as on families. Unexplained infertility defined as inability of a couple to conceive after one year of unprotected intercourse even in the absence of any specific reason for it. Aim: To compare the efficacy of letrozole and clomiphene citrate among patients presenting with unexplained infertility Study design: Prospective observational study. Place and duration of study: Department of Obstetrics &amp; Gynecology, Sheikh Zayed Women Hospital Larkana from 1st January 2020 to 31st December 2020. Methodology: Three hundred and thirty six women having unexplained infertility were randomly allocated into two groups. One hundred and sixty eight patients in group A were given letrozole 2.5mg and 168 women in group B received clomiphene citrate 50mg for three months with successive increase in dose up to 3 cycles, if not conceived in first cycle. They were assessed for pregnancy after 4, 8 and 12 weeks of treatment. Results: The average age of the patients was 27.01±2.53 years. Efficacy of letrozole was significantly high as compare to clomiphene citrate [82.1%vs.62.5%;p=0.0005]. Conclusion: The efficacy of letrozole was significantly high as compared to clomiphene citrate. Letrozole is a better alternative for ovulation induction in anovulatory women because it has high pregnancy rates with shorter time to pregnancy and chances of multiple pregnancies are less because of high monofollicular growth. Keywords:-Infertility, Clomiphene citrate, Letrozole, Unexplained infertility.

A Study of Comparison of Effectiveness of Letrozole (5mg) Versus Clomiphene Citrate (100 Mg) by Using Injection Human Placental Extract (HPE) for Ovulation Induction among Infertile Women

Aim &amp; Objective: To compare the efficacy of letrozole and clomiphene citrate (CC) by using injection of Human placental extract (HPE) for ovulation induction in infertile women. Introduction: Human placental extract (HPE) is a product of aqueous extraction from the biochemically enriched fresh human placenta which contains nucleotides, amino acids, peptides and vitamins in natural form. It is available as 2 ml ampule. Each ml. is derived from 0.1 gm. of fresh human placenta. Injection of HPE is used in infertility treatment for its anti-inflammatory property, due to which tubal inflammation is decreased and tubal motility increases which is useful for fertility. This is the hypothetical theory behind use of Injection of HPE for infertility treatment in infertile women. Clomiphene citrate has been traditionally used as drug of the choice for treatment of women with infertility. In the last decade, an aromatase inhibitor, letrozole has emerged as an alternative ovulation induction (OI) agent in anovulatory women with polycystic ovarian syndrome. Letrozole has a definitive role in anovulatory women who have not responded to clomiphene citrate therapy and this is confirmed by literatures. Background: Anovulatory dysfunction is a common problem and is responsible for about 40% of female infertility and among causes; PCOS (polycystic ovarian syndrome) is the leading cause. HPE is a product of aqueous extraction from the biochemically enriched fresh human placenta which contains nucleotides, amino acids, peptides and vitamins in natural form. HPE injection- properties: • Specific anti – inflammatory • Tissue repair–wound healing • Immunomodulatory • Melanopoetic • Debridement action It is useful in ovulation induction among infertile women who are infertile due to pelvic inflammatory disease (PID) or due to polycystic ovary syndrome (PCOS) because of its anti-inflammatory property which leads to reduction in tubal inflammation and increased tubal motility. Clomiphene citrate is considered as the first line of treatment for anovulatory dysfunction for a various reason, however Clomiphene citrate has some drawbacks like multi-follicular ovulation and Peripheral anti-estrogenic effect are areas of concern and desire for an effective alternative is need of the hour. An aromatase inhibitor, letrozole, was introduced into infertility practice in the year 2000 and is regarded as a second line option, particularly in women with clomiphene resistance and it has found acceptance in various clinical situations and the indications for its use have expanded. Design: Randomized double blind study. Setting: Scientific Research Institute, Surendranagar, Gujarat, India and a private practice setting. Patients &amp; Methods: The study included 100 women who presented with infertility and were having polycystic ovary syndrome (PCOS). The study participants were divided into 2 groups of 50 each. With these injections, 1 group was given clomiphene citrate (100 mg daily) and another group was given; letrozole (5 mg daily), started from day 3 to day 5 of the menstruation cycle and continued up to 5 consecutive days. Both the groups have received Estradiol Valerate 4 mg. on the 12th day of menstruation until 16th day of menstruation; with visits to determine ovulation and pregnancy, followed by tracking of pregnancies. Selected participants were of age between 20 to 39 years, had normal uterine cavity and had intercourse with male partner with a sperm concentration of at least 14 million per millilitre; and during the study the women and their partners agreed to have regular periodical intercourse with the intent of successful conception. The live birth of baby during the treatment period was the primary outcome. Second Outcome Measures: Follicular growth, endometrial thickness, pregnancy outcome. Results: Women who received Letrozole had more cumulative live births than those women who had received Clomiphene Citrate, (38 out of 50 [76%] vs. 29 out of 50 [58%]) after giving Injection of HPE with these ovulation induction drugs, without significant differences in overall congenital anomalies, with letrozole, as compared to clomiphene, the cumulative ovulation rate was higher. Clomiphene was associated with more numbers of episodes of hot flushes while letrozole was associated with fatigue and dizziness. Rates of other adverse effects were almost similar between these 2 groups. A significant difference in the follicular and endometrial development was evident between these 2 groups. Conclusion: Treatment with Injection of HPE with 2 ovulation induction drugs, Letrozole &amp; Clomiphene Citrate - as compared to clomiphene, letrozole - an aromatase inhibitor, was associated with higher live-birth and ovulation rates in infertile women. The results of the study demonstrated that letrozole is non inferior to clomiphene citrate in the maintenance of endometrial thickness.