Ovulation Induction In Infertile Women Research Articles

Clomiphene citrate plus letrozole versus clomiphene citrate alone for ovulation induction in infertile women with ovulatory dysfunction: a randomized controlled trial

BackgroundThe aim of this study was to compare the efficacy of the combination of clomiphene citrate (CC) and letrozole to that of CC alone in inducing ovulation in infertile women with ovulatory dysfunction.MethodsA randomized controlled trial was conducted at a single academic medical center between November 2020 and December 2021. Anovulatory infertility females, aged 18 to 40, were evenly distributed by a computer-generated block of four into two treatment groups. A “combination group” received a daily dose of CC (50 mg) and letrozole (2.5 mg), while a “CC-alone group” received a daily dose of CC alone (50 mg). The study medications were administered on days 3 through 7 of menstrual cycle. The primary outcome was the ovulation rate, defined by serum progesterone levels exceeding 3 ng/mL at the mid-luteal phase. The secondary outcomes were ovulation induction cycle characteristics, endometrial thickness, conception rate, and adverse events.ResultsOne hundred women (50 per group) were enrolled in the study. The mean age was not significantly different in both groups: 31.8 years in the combination group and 32.4 years in the CC-alone groups (P = 0.54). The prevalence of polycystic ovary syndrome in the combination and CC-alone groups was 48% and 44%, respectively (P = 0.841). According to intention-to-treat analysis, the ovulation rates were 78% and 70% in the combination and CC-alone groups, respectively (P > 0.05). There was no significant difference in the mean endometrial thickness or the number of dominant follicles of the groups. No serious adverse events were observed in either group.ConclusionsOur study found no significant difference between the combination of CC and letrozole and CC alone in inducing ovulation in infertile women with ovulatory dysfunction in one cycle. The small number of live births precluded any meaningful statistical analysis. Further studies are needed to validate and extend our findings beyond the scope of the current study.Trial registrationThe study was registered at https://www.thaiclinicaltrials.org with the following number: TCTR20201108004 and was approved on 08/11/2020.

Effect of Letrozole and Clomiphene Citrate versus Letrozole Alone for Ovulation Induction in Women with Polycystic Ovary Syndrome

Background: Polycystic ovary syndrome (PCOS) is a common endocrinopathy characterized by oligo-ovulation or anovulation signs of androgen excess and multiple small ovarian cysts. It is thought to be one of the leading causes of female sub-fertility. It has been estimated that PCOS affects 5-10% of females in reproductive age. In this study, we used combination of letrozole and clomiphene vs letrozole alone in ovulation induction in infertile PCOS women. Objective: The objective of the study was to compare the effectiveness of the combination of letrozole and clomiphene citrate and letrozole alone in ovulation induction in infertile women with PCOS. Methods: Randomized controlled trial conducted in the Department of Reproductive Endocrinology and Infertility, Bangabandhu Sheikh Mujib Medical University, Dhaka, from July 2020 to June 2021. A total of 50 women 18-40 years of age with a diagnosis of infertility and PCOS as defined by the Rotterdam criteria and no other known cause of infertility were included in this study. Participants were randomly assigned into two groups by using a computer-generated random table to either 5 mg letrozole alone or the combination of 2.5 mg letrozole and 50 mg CC daily on cycle days 3-7 for two treatment cycle. Statistical analysis was performed by the SPSS program for Windows, version 22.0. Main outcome measured by number & size of mature follicles, endometrial thickness, day 21 serum progesterone & ovulation rate in both groups. The secondary outcome includes pregnancy rate and complication of both treatment arms. Results: Regarding demographic criteria, there was no significant difference between two groups. In the current study, clinical characteristics, laboratory parameters and cycle characteristics were also comparable to both groups and showed no significant difference. Dominant follicles were found 24(52.2%) in group A (CC+Letrozole) and 29(63.0%) in group B (Letrozole Alone) without any significant difference. Mono follicular development was found 18(75.0%) in group A and 24(82.8%) in group B which was not statistically significant. Endometrial thickness and serum progesterone level at 1st and 2nd cycle were not statistically significant between two groups (p>0.05). Ovulation rate was higher in group B than group A (76.0% vs 72.0%) with absolute difference 4.0 and relative ratio 0.95. Pregnancy rate was also higher in group B than group A (24.0% vs 16.0%) with absolute difference 8.0 and relative ratio 0.67. Ovulation and pregnancy rate were not statistically significant between two groups. Regarding side effects, no significant difference was found between two groups. Conclusion: Although it was not statistically significant, ovulation and pregnancy rate was a little higher in alone letrozole group than combined group. The results of this preliminary study suggested that letrozole may have a better role as a first-line treatment for anovulatory patients with PCOS.

The Effect of Metabolic Persian Diet on Ovulation Induction in Infertile Women.

Infertility is an important issue with a high social and psychological burden. From the perspective of Persian Medicine (PM), uterine cold temperament is one of the important causes of female infertility. The aim of this study was to study the effect of PM or Iranian traditional medicine on improving ovulation and fertility. From January 2017 to August 2017, sixty infertile women with eugonadotropic ovulation disorder were randomly divided into two groups. Both groups were treated with clomiphene citrate, except that the intervention group also received metabolic Persian diet (MPD). In each cycle, the dominant follicles and endometrium were investigated with ultrasound. At the end of the cycle, beta human chorionic gonadotropin (β-HCG) was evaluated and if positive, another ultrasound was performed two weeks later to confirm early pregnancy. The number of dominant follicles from the first to third cycle increased from 2.15 ± 1.14 to 2.28 ± 0.61 in the intervention group and decreased from 1.86 ± 0.79 to 1.30 ± 0.47 in the control group. The dominant follicle size changed from 16.00 ± 4.08 to 18.78 ± 2.78 and from 15.05 ± 3.11 to 15.80 ± 3.89 in the intervention and control groups, respectively. But endometrial thickness did not change significantly in the intervention group. Pregnancy results based on β-HCG and ultrasound findings were positive in 19 and 16 patients in the intervention group and in 10 and 7 patients in the control group, implying significantly higher numbers in the first group. It seems that MPD may be effective in the success of ovulation induction.

Aromatase inhibitors (letrozole) for ovulation induction in infertile women with polycystic ovary syndrome.

Aromatase inhibitors (letrozole) for ovulation induction in infertile women with polycystic ovary syndrome.

P-688 Combination of letrozole and clomiphene citrate versus letrozole alone for ovulation induction in women with polycystic ovary syndrome - a randomized controlled trial

Abstract Study question Does clinical pregnancy rate improve using combination of letrozole and clomiphene versus letrozole alone for ovulation induction in infertile women with PCOS Summary answer The present study showed that combination drugs had no added advantage over Letrozole alone in terms of ovulation induction. What is known already Letrozole can offer a benefit over CC for ovulation induction because it doesn’t block estrogen receptors in both central and peripheral target tissues, therefore normal central feedback mechanisms remain intact. As letrozole and CC have different mechanisms of action, the combination of these medications can achieve an improved ovulatory rate over letrozole alone. We aimed to test the hypothesis of whether combined therapy of letrozole and CC is effective and superior to the use of letrozole alone to achieve pregnancy in women with PCOS. Study design, size, duration Prospective Randomized Controlled Trial conducted from July 2019 to December 2020 at tertiary care centre in Uttarakhand According to studies done earlier (49), it was observed that proportion of positive outcome in letrozole and clomiphene citrate combined therapy was assumed to be 0.7700 and for letrozole therapy alone was 0.4400. With significance level of 0.05 and power 90% a sample size of 42 in each group to detect assumed 0.33 difference between the two groups. Participants/materials, setting, methods 68 patients randomised in two group. Group I received combination of Letrozole (2.5mg) and clomiphene citrate (50 mg) once daily for 5 days (day 3-7 of cycle). Group II received Letrozole 2.5mg once daily for 5 days (day 3-7 of cycle) for 4 cycles. After induction follicular monitoring done and HCG given when dominant follicle size > =18mm with ET > =8mm followed by timed intercourse. Main results and the role of chance No statistically significant difference seen between the two groups in baseline characterstics. Comparing the pregnancy rate, 9.3% in Group 1 (n = 3) & 6.3% in Group 2 (n = 2) became pregnant after first cycle of ovulation induction (OVI), after 2nd cycle, 7.1% in Group 1 (n = 2) & 13.8% in Group 2 (n = 4) became pregnant. 11.5 % in Group 1 (n = 3) & 8.0 % in Group 2 (n = 2) became pregnant after cycle 3 and 21.7% in Group 1 (n = 5) & 8.7% in Group 2 (n = 2) became pregnant after 4th cycle of OVI. Though the pregnancy rate was statistically not significant in all the cycle (p < 0.615,0.413,0.671,0.218 respectively). The median number of cycles required for conception in Group 1 was 3 and that of group 2 was 2. Limitations, reasons for caution Small sample size Larger multicentric randomised controlled trials required Wider implications of the findings Pregnancy rate was higher when ovulation induction was done using combination of clomiphene and letrozole but difference was not statistically significant. Mean number of cycles required for conception similar in both groups. Trial registration number CTRI no: CTRI/2020/06/025688

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 & 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 & 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 & 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.

A study of comparison of effectiveness of letrozole (5mg) versus clomephene citrate (100 mg) for ovulation induction among infertile women

Clomiphene citrate has been traditionally used as the drug of the 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 the clomiphene citrate therapy is confirmed by literatures. 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 is considered as the drug of choice for the first line treatment of anovulatory dysfunction for a variety of reasons. Clomiphene citrate has some side effects like multi-follicular development and cyst formation and resistance of clomiphene are areas of concern and desire for an effective alternative persists.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 use have expanded., To compare the efficacy of letrozole and clomiphene citrate (CC) for ovulation induction in infertile women. The study included 100 women presented with anovulatory infertility. The infertile women were divided into 2 groups of 50: Group A received 100 mg Clomiphene Citrate from day 3 to day 5 of menstruation and Estradiol Valerate 4 mg on the 12 day of menstruation until 16 day of menstruation; Group B treated by 5 mg Letrozole from day 3 to day 5 of the menstruation and as Group A, Estradiol Valerate 4 mg on the 12 day of menstruation until 16 day of menstruation given to Group B, with visits to determine ovulation and pregnancy, followed by tracking of pregnancies. Participants were of 20 to 39 years age, had normal uterine cavity and had a 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 intercourse with the intent of conception. The live birth during the treatment period was the primary outcome. Women who received letrozole had more cumulative live births than those women who had received clomiphene citrate (36 out of 50 [72%] vs. 28 out of 50 [56%]), without significant differences in overall congenital anomalies, there were no congenital anomalies. With letrozole as compared to clomiphene the cumulative ovulation rate was higher. Higher incidence of hot flushes was associated with a clomiphene, and letrozole was associated with fatigue and dizziness. Rates of other adverse effects were almost similar among these 2 groups. A significant difference in the follicular and endometrial development was evident among these 2 groups. As compared to with clomiphene, an aromatase inhibitor, letrozole was associated with higher live-birth and ovulation rates among infertile women. The results of the study demonstrated letrozole to be superior to clomiphene citrate in the maintenance of endometrial thickness.

Higher ovulation rate with letrozole as compared with clomiphene citrate in infertile women with polycystic ovary syndrome: a systematic review and meta-analysis.

Polycystic ovary syndrome (PCOS) is a common cause of anovulatory infertility. According to the latest guidelines, letrozole should be considered as the first-line pharmacological treatment for women with WHO Group II anovulation or PCOS. However, the use of letrozole as an ovulation induction agent is not FDA or EMA approved, and its use is "off-label." The main concern with respect to letrozole regards its potential teratogenic effect on the fetus. To determine whether the probability of ovulation is higher with letrozole as compared to clomiphene citrate (CC) in anovulatory women with PCOS. Randomized controlled trials (RCTs) comparing letrozole versus CC used for ovulation induction in infertile women with PCOS followed by timed intercourse (TI) or intrauterine insemination (IUI) were included in this meta-analysis. Primary outcome was ovulation. Secondary outcomes were live birth, clinical pregnancy, miscarriage, multiple pregnancy, and congenital anomalies. Subgroup analysis included patients who received letrozole or CC as first-line treatment, and patients with PCOS diagnosed according to the Rotterdam criteria. Twenty-six RCTs published between 2006 and 2019, involving 4168 patients who underwent 8310 cycles of ovulation induction, were included. The probability of ovulation was significantly higher in letrozole as compared to CC cycles (RR: 1.148, 95% CI: 1.077 to 1.223, 3017 women, 19 trials, I2: 47.7%, low-quality evidence). A higher probability of ovulation is expected in infertile patients with PCOS treated with letrozole as compared to CC. The higher ovulation rate might have contributed to the higher clinical pregnancy and live birth rate. This finding is also true for patients who were administered letrozole as first-line treatment. CRD42019125166.

Letrozole versus clomiphene citrate for ovulation induction in anovulatory women with polycystic ovarian syndrome: A randomized controlled trial.

To compare the efficacy of letrozole and clomiphene citrate (CC) for ovulation induction in infertile women with polycystic ovarian syndrome (PCOS). In this assessor blind, randomized controlled trial, 90 infertile women with PCOS were randomized to receive either letrozole or CC for ovulation induction in incremental doses for a maximum of three cycles. Main outcome measures studied were endometrial thickness, ovulation rate, pregnancy rate, rate of monofollicular development, and time to conception. Mean endometrial thicknesses were 9.86±2.32mm and 9.39±2.06mm with letrozole and CC, respectively (P=0.751). Cumulative ovulation rates were 86.7% and 85.2% with letrozole and CC, respectively (P=0.751). Pregnancy was achieved in 42.2% of women in the letrozole group and 20.0% of women in the CC group (P=0.04). Monofollicular development was seen in 68.4% of ovulatory cycles in the letrozole group compared with 44.8% in the CC group (P=0.000). Mean time to achieve pregnancy was significantly shorter (log rank P=0.042) with letrozole (9.65weeks) than with CC (11.07weeks). Letrozole is a better alternative for ovulation induction in anovulatory women with PCOS as pregnancy rates are higher, time to pregnancy is shorter, and chances of multiple pregnancy are less because of high monofollicular growth.

To study the comparison of efficacy of letrozole versus clomiphene citrate for ovulation induction in infertile women with PCOS in Indian population

Background: The aim of the study was to study the comparison of the efficacy of letrozole versus clomiphene citrate (CC) for ovulation induction in infertile women with polycystic ovary syndrome (PCOS) in Indian population. Methods: This prospective trial included 92 infertile women with PCOS. Letrozole dose of 2.5 mg/day (n = 47) or a CC dose of 100 mg/day (n = 45) was given from day 3 to day 7 of the menstrual cycle. Follicular monitoring was started from day 7 and done until the mean diameter of the largest follicle reached 18 mm, then, 5000 IU of human chorionic gonadotropin (HCG) was given. Intrauterine insemination was done in two sittings, 24 and 48 hours after HCG. Statistical testing was conducted with SPSS 17.0. Results: The clinical profile of patients belonging to both groups were comparable. The number of follicles ≥18 mm on the day of HCG was 1.11 ± 0.43 for the letrozole group and 2.53 ± 1.10 for the CC group (P

Ovulation induction in infertile women with endometriotic ovarian cysts: current evidence and potential pitfalls.

Endometriosis is a chronic benign gynecological disease with symptoms that can severely impact quality of life and well-being. Women affected by endometriotic ovarian cyst could have associated infertility problems. Infertility affects 30% to 50% of women with endometriosis. Women with endometriosis are at risk of decreased ovarian reserve, due to the disease pathophysiologic mechanisms. Generally, infertility management include surgical procedure (usually with minimally invasive approach) and ovulation induction with intrauterine insemination or in vitro fertilization. Fertility preservation technologies also include oocyte or embryo freezing and ovarian tissue cryopreservation. Approach to patients with endometriotic cysts still remains controversial, and a multidisciplinary approach is a key factor to achieve the best outcome with appropriate patient counselling. Such management by a multidisciplinary team is a key factor in achieving the successful outcome.

Comparing the Effect of Clomiphene Citrate and Letrozol on Ovulation Induction in Infertile Women with Polycystic Ovary Syndrome

To compare the effects of letrozole and clomiphene citrate in women with polycystic ovaries. The double-blind randomised clinical trial study was conducted from September 22, 2012 to March 20, 2013, at the Islamic Azad University of Medical Sciences, Mashad, Iran, and comprised infertile women with polycystic ovaries. The subjects were classified into two groups. Patients who received letrozole 5mg tablets per night formed group A, and those who received clomiphene citrate 50mg tablets per night formed group B. The medication continued for 3-7 days in each group. On the 13th day, transvaginal sonography with multi-frequency vaginal probe was done to check the number and the size of dominant follicle and endometrial thickness. Human chorionic gonadotrophin 5000 IU ampoule, 10000 IU per night, was administered intramuscularly for ovulation in the case of dominant follicle over 18mm and the insemination was recommended 24-36h after injection. Beta human chorionic gonadotrophin was determined 16 days after the injection by immunoassay technique. The patients were followed up for 12 months. SPSS 16 was used for data analysis. There were 220 patients; 110(50%) in each of the two groups. The mean age of patients in group A was 26.2±3.6 years and that in group B was 27±3.6 years. Endometrial thickness in group A was significantly greater compared to group B (p=0.001). The clinical consequence of drug use (pregnancy) in group A was better than group B (p=0.007). Although more clinical studies are needed, letrozole is recommended for women with polycystic ovaries and those resistant to clomiphene citrate.

Biosimilar FSH Preparations Versus Highly Purified Urinary FSH for Simple Ovulation Induction in Infertile Women with Polycystic Ovary Syndrome

Biosimilar FSH Preparations Versus Highly Purified Urinary FSH for Simple Ovulation Induction in Infertile Women with Polycystic Ovary Syndrome

Clinical Observation of 242 Cases of Polycystic Ovary Syndrome

Objective: To compare the clinical effect and safety between letrozole (LE) and clomiphene citrate (CC) stimulated cycles in women with polycystic ovary syndrome (PCOS). To evaluate the effectivenesses and benefits of letrozole for ovulation induction in infertile women with PCOS. Methods: We retrospectively analyze the clinical data of 242 cases of the first ovulation induction cycle patients with PCOS, who referred to the Department of Reproductive Medicine, The First Affiliated Hospital of Yangtze University from June 2016 to June 2018, and were randomly divided into letrozole group and control group. The experimental group received Letrozole 2.5 mg/d for 5 days during days 3 - 7 of menstrual cycle. The control group was given clomiphene citrate 100 mg/d for 5 days during days 3 - 7 of menstrual cycle. Progynova will be used when the follicular diameter is 14 mm. Results: Letrozole group had less mature follicles, lower estrogen levels, thicker endometrium and higher ovulation rate in HCG day. But there is no difference between two groups in clinical pregnancy rate, single pregnancy rate, abortion rate, prenatal pregnancy delivery and newborns. Conclusion: Letrozole and clomiphene citrate have similar effect on ovulation induction, but we still need a lot of clinical data of letrozole about the safety of follicle, embryo, fetus and newborns.

Comparing the Effect of Metformin and Acarbose Accompanying Clomiphene on the Successful Ovulation Induction in Infertile Women with Polycystic Ovary Syndrome.

The aim of this study was to compare the effects of Metformin and Acarbose accompanying Clomiphene on the successful ovulation induction in infertile women with polycystic ovary syndrome. This randomized double blind clinical trial study was performed on 60 women with polycystic ovary syndrome. Women were selected and randomly divided in two control and intervention groups. Intervention group received Acarbose 100 mg/day for 3 months. In the first, second, and third weeks, they received 1 tablet, 2 tablets, and 3 tablets per day respectively. In addition, they received 100 mg Clomiphene from third to seventh day of menstruation, during the 3 month treatment period. The control group received Metformin 500 mg/day for 3 months. In the first, second, and third weeks, they received 1 tablet, 2 tablets, and 3 tablets per day respectively. In addition, they received 100 mg Clomiphene from third to seventh day of menstruation, during the 3 month treatment period. All the subjects in both groups before and after the treatment were examined for hirsutism, acne, oral glucose tolerance test, serum triglycerides, cholesterol, LDL, HDL. Also, induction of ovulation was assessed by vaginal ultrasound. The Mean of BMI and fasting glucose tolerance test in Acarbose group was less than Metformin group (P = 0.05). The mean of triglycerides, LDL and HDL levels did not differ between the two groups after the intervention (P > 0.05). The mean of cholesterol levels were different in the two groups after the intervention (P = 0.04). Frequency of ovulation induction in those who received Acarbose (78.5%) was more than those who received Metformin (46.6) (P = 0.012). Comparing with Metformin, Acarbose accompanying Clomiphene was more effective in ovulation induction and decreasing body mass index in infertile women with polycystic ovary syndrome.

Long versus short course treatment with metformin and clomiphene citrate for ovulation induction in women with PCOS.

Polycystic ovary syndrome (PCOS) is the most common endocrinopathy among reproductive-aged women. Apart from infertility, women with PCOS often have other endocrine disorders, including insulin resistance, hyperinsulinaemia and hyperandrogenism. Metformin,combined with clomiphene citrate (CC), has been shown to be more effective in ovulation induction when compared with clomiphene citrate alone. The optimal duration for metformin pretreatment before initiation of clomiphene citrate, however, is unknown. To determine the effectiveness of short-course (less than four weeks) metformin plus CC versus long-course (four weeks or more) metformin plus CC with regard to ovulation and achievement of pregnancy in infertile women with PCOS. We searched the Cochrane Menstrual Disorders and Subfertility Group Trials Register, the Cochrane Central Register of Controlled Trials, MEDLINE, CINAHL, EMBASE and PsycINFO (all from inception to 1 February 2012). Randomised controlled trials comparing short-course (less than four weeks) metformin plus CC versus long-course (four weeks or more) metformin plus CC for ovulation or achievement of pregnancy in infertile women with PCOS. No trials were found that met the selection criteria. No randomised controlled trials were identified. There are insufficient data to determine whether short-course metformin pretreatment is as effective as the conventional long-course metformin pretreatment before initiation of clomiphene citrate for ovulation induction in infertile women with PCOS. A well-designed randomised controlled trial is needed to answer this important clinical question.

Effects of metformin in reducing insulin resistance and reversing gonadotrophin levels (LH, FSH) followed by ovulation induction in infertile women with polycystic ovarian syndrome

<strong>Objectives:</strong><em> </em>To evaluate the effectiveness of metformin in reducing insulin resistance, reversing the LH:FSH and followed by ovulation induction in infertile Bangladeshi patients with polycystic ovarian syndrome (PCOS). <strong>Materials and methods: </strong>Cases were infertile patients with PCOS (n=35, age range &ndash; 18-35 years/Mean, age&plusmn;SD &ndash; 25.68&plusmn;3.81 years, infertility &ndash; 1.5-10.0 years, Mean&plusmn;SD &ndash; 4.12&plusmn; 1.21 years) obtained from OG-OPD at MCW&amp;H, Dhaka. Infertile Bangladeshi couples without PCOS (n=30) were included as controls. After fasting blood samples were collected at inclusion (PCOS-I&ordm;), metformin was prescribed (850 mg bd) and they were followed up after 2 months when fasting blood samples were taken again (PCOS-II&ordm;). Blood levels of glucose, insulin, insulin resistance (HOMA-IR), LH, FSH and LH:FSH were measured by standard laboratory methods. The patients were then given letrozole (aromatase inhibitor) (5 mg daily for 5 days from 2nd day of cycle) and were continued for 3 consecutive cycles for pregnancy. <strong>Results:</strong><em> </em>Raised levels of insulin and HOMA-IR in PCOS-I&ordm; were reduced significantly by metformin treatment (PCOS-I&ordm; vs PCOS-II&ordm; P&lt;0.001), but not to the control levels. Similarly, the elevated levels of LH, FSH and LH:FSH were lowered significantly (PCOS-I&ordm; vs PCOS-II&ordm; P&lt;0.001), but again not to the full extent of control levels. Only 12/35, i.e. 34.28% patients became pregnant after 3 months of letrozole treatment. Of the 12 (34.28%) pregnancy positive patients, 5 (14.28%) and 7 (20%) were obese and non-obese respectively which was not statistically different (P&gt;0.25).<em> </em> <strong>Conclusions:</strong><em> </em>In 34.28% of the PCOS patients, insulin resistance and LH:FSH could be corrected and a successful conception was achieved by letrozole. In rest of the cases some other factors may be involved which could not be addressed by letrozole alone. <strong>Key words: </strong>PCOS; metformin; insulin resistance; FSH; LH.<em></em> <span style="font-family: 'Verdana','sans-serif'; color: #111111;">DOI: <a href="http://dx.doi.org/10.4038/sljog.v33i3.4017">http://dx.doi.org/10.4038/sljog.v33i3.4017</a>&nbsp;</span>&nbsp; <em>Sri Lanka Journal of Obstetrics and Gynaecology </em>2011; <strong>33</strong>: 98-103 <em></em>

Randomized controlled trial of different doses of metformin for ovulation induction in infertile women with polycystic ovary syndrome

To compare the efficacy of 1000 mg and 1700 mg of metformin on ovulation induction in polycystic ovary syndrome (PCOS) women. A randomized controlled trial was conducted at Ramathibodi Hospital, Mahidol University, Bangkok, Thailand of 60 PCOS women diagnosed by Rotterdam criteria. Group A (30 women) and B (30 women) received 1000 mg and 1700 mg/day of metformin, respectively. Clomiphen citrate 50-150 mg per day for 5 days was added, if no dominant follicle developed. The main outcome measures were ovulation and pregnancy rates, fasting insulin (FI), testosterone (T), androstenedione (ADD) and DHEAS before and 4 weeks after metformin. The ovulation rate did not differ between the groups (84.8% vs 87.7% between groups A and B, P=NS). Most of the women developed one follicle (91% in group A and 88.2% in group B, P=NS). The pregnancy rate in group A (46.4% per woman and 12.4% per ovulatory cycle) did not differ from that in group B (51.9% per woman and 13.2% per ovulatory cycle, P=NS). With regard to dosages, the ovulation rate in PCOS women without insulin resistance (IR) was significantly higher than those with IR. FI, T and ADD were significantly decreased after 4 weeks of metformin in both groups. 1000 mg of metformin had as high efficacy as 1700 mg on induction of ovulation and pregnancy in PCOS women.

Laparoscopic Ovarian Drilling by Diathermy for Ovulation Induction in Infertile Women with Polycystic Ovarian Syndrome

Background : Polycystic ovarian syndrome (PCOS) is the commonest cause of secondary infertility. Lapa-roscopic ovarian drilling has widely been used for in-duction of ovulation in polycystic ovarian syndrome patients resistant to clomiphene citrate. 80% patients ovulated after treatment and 60% patient conceived either spontaneously or after treatment with medi-cation to which they are previously resistant. Purpose: The aim of the present study was to see the effectiveness of laparoscopic ovarian drilling (LOD) with monopolar diathermy on pregnancy outcome in infertile women with polycystic ovarian syndrome (PCOS). Design: Descriptive cross sectional study. Intervention: Laparoscopic ovarian drilling. Main Outcome Measures: Pregnancy, ovulation rate. Material and Methods: This study was carried out in the department of Gynae and Obstetrics in Sharif Medical City Hospital from January, 2007 to January, 2009. The inclusion criteria for laparoscopy ovarian drilling (LOD) were those infertile women between the age group of 25 - 38 years who meet the criteria for PCOS and who are resistant to clomiphene citrate and injectable gonadotrophins. A total of 30 women were booked for laparoscopic ovarian drilling after having informed consent for procedure. Response to therapy was assessed in term of pregnancy outcome and ovulation rate for 1 year after therapy. Results: A total of 30 patients were booked for lapa-roscopic ovarian drilling from January, 2007 to Jan-uary, 2009. The mean age of study group was 30 years ± SD 4.7791. Cumulative ovulation rate was observed in 22 patients (73%), out of which spontaneous ovula-tion occurred in 18 patients (80%), and after ovulation induction therapy in 4 patients (18%). Eleven patients (37%) conceived in two year duration. Spontaneous conception without any treatment was observed in 7 patients (63%); however 4 patients (37%) require fur-ther assistance with combined therapy of clomiphene citrate and injectable gonadotrophins after failure of ovulation induction. Miscarriage occurred in none of our patients. Mean age of conceived group was 29.36 ± SD 5.07 years; with mean duration of infertility 5.136 ± SD 4.605 years. Most of the patients concei-ved in first 4 months of LOD i.e 8 patients (72%), two patients (18%) in further 8 months, and 1 patient in 1 year duration. Mean interval of conception was 3.95 ± SD 4.14 months after laparoscopic ovarian drilling. None of our patient lost follow up. Conclusion: Laparoscopic ovarian drilling is safe, cost effective treatment in patients with polycystic ovarian syndrome. Spontaneous ovulations were ob-served within 2 - 3 months, and maximum conception occurred in 6 to 9 months of treatment with LOD. Key Words: PCOS, Laparoscopy.

Factors related to successful ovulation induction in patients with WHO group II anovulatory infertility

To identify baseline characteristics related to successful ovulation induction, data were analysed from oligo- or anovulatory patients undergoing their first cycle of human recombinant FSH (r-hFSH; follitropin alfa) in a chronic low-dose (75 IU starting dose), step-up protocol in two clinical trials (n=446). Patients were grouped according to response: group A, ovulated within 14 days (75 IU follitropin alfa); group B, ovulated after 14 days (>75 IU follitropin alfa); group C, not administered human chorionic gonadotrophin (HCG) because of poor response; group D, cycle cancelled due to over-response (HCG not administered); group E, spontaneous ovulation prior to obtaining criteria for administration of HCG. Mean body mass index (BMI) of group A (25.0 kg/m(2)) was significantly lower than groups B (27.1 kg/m(2), P<0.001) or C (28.2 kg/m(2), P<0.0001), but similar to group D (24.3 kg/m(2)). Mean antral follicle count (AFC) of group A was also significantly lower than group C (18.3 versus 22.7; P=0.018), but not significantly different from groups B (21.5) or D (19.5); group E had the highest mean AFC (35.7). Comparatively low BMI, low AFC and higher (although still within the normal range) FSH concentration at baseline were associated with successful ovulation induction in infertile women undergoing a chronic low-dose, step-up stimulation protocol.