Alaa Mohammed Sadeq¹, Sarah Majeed Kareem
Polycystic ovary syndrome (PCOS) is associated with anovalation and a common cause of infertility, Clomiphene citrate has traditionally used as a drug of choice in treating women with anovulatory PCOS, in the last decade letrozole, an aromatase inhibitor has emerged as an alternative ovulation induction agent. The objective of this study is to compare the effects of letrozole and clomiphene citrate as an ovulation induction drug in subfertile PCOS women. The subfertile PCOS women were treated randomly with 5 mg letrozole or 100mg clomiphene citrate from day 3 menstrual cycle for 5 days. The main outcome of this study are: ovulation rate; mono or multi follicular rate; days to ovulation; endometrial thickness; and serum estradiol levels and pregnancy rate. Letrozole group was higher in number of responsive when compared with CC group but still not significant. In letrozole group the number of monofollicle cycle was higher (69.57%) and multifollicles cycle was low (30.43%) when are comparing with that of CC group. In conclusion, letrozole in patients with PCOS is as effective as clomiphene citrate in inducing ovulation, ovulation rate and the incidence of pregnancy was higher with letrozole than that with clomiphene citrate. A part from that, letrozole treatment is prone to a production of monofollicles.
Keywords: Letrozole; Clomiphene citrate; Polycystic ovary syndrome
Copyright © 2016 by The American Society for BioMedicine and BM-Publisher, Inc.
- Beinsden PR, Balen AH. Textbook of Invitro Fertilization and Asisted Reproduction. 3rd edition, 2007:189-215.
- Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril 2004;81:19-25. [PubMed]
- Gardner DK, Weissman A, Tang TH. Polycystic ovaries and ART in: Textbook Of Reproductive Technologies. 3rdedition. 2010;53:721-735.
- Young SL, Opsahl MS, Fritz MA. Serum concentrations of eclomiphene and zuclomiphene across consecutive cycles of clomiphene citrate therapy in anovulatory infertile women. Fertil Steril 1999;71:639-644. [PubMed]
- Rao KA, Carp H, Fische R, Abha M, Sharma MN. Anovulatory infertility in: Principle and Practice of Assisted Reproductive Technology. 1st edition 2014; vol 1:165-182.
- Ataollah Ghahiri, Neda Mogharehabed, Mahboobeh Mamourian. Letrozole as the first-line treatment of infertile women with poly cystic ovarian syndrome (PCOS) compared with clomiphene citrate: A clinical trial. Adv Biomed Res 2016;5:6. [PubMed]
- Holzer H, Casper R, Tulandi T. A new era in ovulation induction. Fertil Steril 2006;85:277-284. [PubMed]
- Topipat C, Choktanasiri W, Jultanmas R, et al. A comparison of the effects of clomiphene citrate and the aromatase inhibitor letrozole on superovulation in Asian women with normal ovulatory cycles. Gynecol Endocrinol 2008;24:145-150. [PubMed]
- Dickey RP, Holtkamp DE. Development, pharmacology and clinical experience with clomiphene citrate. Hum Reprod Update 1996;2:248-506. [PubMed]
- Mitwally MF, Casper RF. Use of an aromatase inhibitor for induction of ovulation in patients with an inadequate response to clomiphene citrate. Fertil Steril 2001;75:305-309. [PubMed]
- Begum MR, Ferdous J, Begum A, Quadir E. Comparison of efficacy of aromatase inhibitor and clomiphene citrate in induction of ovulation in polycystic ovarian syndrome. Fertil Steril 2009;92:852-857. [PubMed]
- Mervet S., Hassan AH. Predictors and characteristics of letrozole induced ovulation in comparison with clomiphene induced ovulation in anovulatory PCOS women. Middle East Fertility Society Journal 2011;16(2):125-30. [Abstract/Full-Text]
- Imani B, Eijemans MJ, te Velde ER, et al. A nomogram to predict the probability of live birth after clomiphene citrate induction of ovulation in normogonadotrophic oligomenorrheic infertility. Fertil Steril 2002;77:91-97. [Abstract/Full-Text]
- Al-Fozan H, Al-Khadouri M, Tan SL, Tulandi T. A randomized trial of letrozole versus clomiphene citrate in women undergoing superovulation. Fertil Steril 2004;82:1561-3. [PubMed]
- Abu Hashim H, Shokeir T, Badawy A. Letrozole versus combined metformin and clomiphene citrate for ovulation induction in clomiphene-resistant women with polycystic ovary syndrome: A randomized controlled trial. Fertility and Sterility 2010;94:1405-9. [PubMed]
- Legro RS, Brzyski RG, Diamond MP, et al. Letrozole versus clomiphene for infertility in the polycystic ovary syndrome. N Engl J Med 2014;371:119-129. [Abstract/Full-Text]
- Badawy A, Abdel Aal AI, Abulatta M. Clomiphene citrate or letrozole for ovulation induction in women with polycystic ovarian syndrome: A prospective randomized trial. Fertil Steril 2009;92:849-52. [PubMed]
- Baruah J, Roy KK, Rahman SM, Kumar S, Sharma JB, Karmakar D. Endometrial effects of letrozole and clomiphene citrate in women with polycystic ovary syndrome using spiral artery Doppler. Arch Gynecol Obstet 2009;279:311-4. [PubMed]
- Atay V, Cam C, Muhcu M, Cam M, Karateke A. Comparison of letrozole and clomiphene citrate in women with polycystic ovaries undergoing ovarian stimulation. Journal of International Medical Research 2006;34:73-76. [Abstract/Full-Text]
- Ghahiri A, Mogharehabed N, Mamourian M. Letrozole as the first-line treatment of infertile women with poly cystic ovarian syndrome (PCOS) compared with clomiphene citrate: A clinical trial Adv Biomed Res 2016;5:6. [PubMed]
- Badawy A, Mosbah A, Tharwat A, Eid M. Extended letrozole therapy for ovulation induction in clomiphene-resistant women with polycystic ovary syndrome: a novel protocol. Fertil Steril 2009;92:236-239. [PubMed]
- Matheus R, Aua C, Marcello V, et al. Letrozole versus clomiphene citrate in polycystic ovary syndrome: systematic review andmeta-analysis. Gynecol Endocrinol 2015;31(12):917-921. [PubMed]
- Awwad JT, Farra CG, Awwad ST, Bu-Habib RM, Abdallah MA, Usta IM. The conventional doses of human chorionic gonadotropins may not always be sufficient to induce ovulation in all women: A reappraisal. Clin Exp Obstet Gynecol 2001;28:240-2. [PubMed]
- Bayar U, Tanriverdi AH, Barut A, Ayoglu F, Ozcan O, Kaya E. Letrozole vs. Clomiphene citrate in patients with ovulatory infertility. Fertil steril 2006;85:1045-8. [PubMed]
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American Journal of BioMedicine Volume 4, Issue 11, pages 455-465
Received June 21, 2016; accepted October 12, 2016; published November 18, 2016
How to cite this article
Sadeq AM, Kareem SM. Clomiphene citrate or letrozole for ovulation induction in infertile polycystic ovarian syndrome women. American Journal of BioMedicine 2016;4(11):455-465.
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