Comparative Effectiveness of Letrozole, Clomiphene Citrate, and Combination Therapy for Ovulation Induction Among Infertile Pakistani Women with Polycystic Ovary Syndrome: A Prospective Comparative Study
DOI:
https://doi.org/10.62497/irjgp.237Keywords:
Polycystic ovary syndrome, Letrozole, Clomiphene citrate, Ovulation induction, Infertility, Pregnancy outcome, PCOSAbstract
Background: Polycystic ovary syndrome (PCOS) is one of the most prevalent causes of anovulatory infertility, and selection of the best ovulation induction regimen is of paramount significance for optimal reproductive outcome.
Objective: To evaluate the comparative effectiveness of letrozole, clomiphene citrate and letrozole + clomiphene citrate therapy for the induction of ovulation and reproduction outcome in infertile Pakistani women with PCOS.
Methodology: A prospective comparative clinical investigation was performed in 330 women with PCOS who were equally divided into 3 groups: letrozole, clomiphene citrate and combination therapy (n=110). The response to ovulation, development of the follicles, the characteristics of the endometrium, pregnancy rates, and any adverse events related to treatment were analyzed and compared using appropriate statistical tests.
Results: Successful ovulation was achieved in 91 (82.73%) women in the letrozole group, 78 (70.91%) in the clomiphene citrate group, and 96 (87.27%) in the combination therapy group (p=0.012). Ovulation rate per cycle was highest with combination therapy (91, 82.42%) compared with letrozole (84, 76.67%) and clomiphene citrate (72, 65.45%) (p=0.008). Combination therapy showed superior follicular and endometrial outcomes, with mature follicles ≥18 mm in 101 (91.82%) participants and endometrial thickness ≥8 mm in 97 (88.18%) participants. Clinical pregnancy occurred in 39 (35.45%) women receiving combination therapy, compared with 32 (29.09%) receiving letrozole and 21 (19.09%) receiving clomiphene citrate (p=0.028). Overall adverse events were highest with clomiphene citrate (36, 32.73%) compared with combination therapy (27, 24.55%) and letrozole (20, 18.18%).
Conclusion: Letrozole was found to be more effective when combined with clomiphene citrate in inducing ovulation and improved reproductive outcome than when used alone in Pakistani women with PCOS.
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