Background: Ovulatory dysfunction is a common cause of infertility and polycystic ovary syndrome (PCOS) is the main reason of this dysfunction. PCOS is the most common endocrinopathy in women of childbearing age. A combination of ovarian stimulation or superovulation with intrauterine insemination (IUI) remains an important option available to an infertility specialist and is a widely used treatment modality for a broad range of indications.
Objective: To compare between Letrozole-Gonadotrophins combination in and Clomiphene Citrate – Gonadotrophins combination in ovarian induction for PCOS Patient undergoing Intrauterine Insemination.
Patients and methods: prospective chohort study was conducted in International Islamic Center for Population Study and Research, Al-Azhar University including 300 infertile women who already diagnosed as PCOS by Rotterdam 2003 Criteria. Women had been divided randomly into three equal groups: Group (A) were given clomiphene citrate 100 mg daily starting on day 3 till 7 day of cycle plus gonadotrophins (75 IU) once daily starting from 6th day of the cycle till growing follicle reach 18 mm, Group (B) were given letrozole (5mg/ day) starting on day 3 till 7 day of cycle plus gonadotrophins 75 IU once daily starting from 6th day of the cycle till growing follicle reach 18 mm and Group (C) were given letrozole (5mg/ day) starting on day 3 till 7 day of cycle.
Results: Women's ovulation rate in Group (A) was 78% had ovulation while in Group (B) 80% had ovulation and 68% in group (C). There were statistically significant differences between groups. Women's pregnancy rate in Group (A) was 8% in Group (B) was 7% in group (C) was 4%. There were no statistically significant differences between groups. Group A showed more multiple follicles, more OHSS and then group B and C. more cancellation rate than group B. Group B showed less in multiple follicles and less OHSS than group A and less in cancellation rate than group A and C better in endometrial thickness. Group C Letrozole alone more monofollicular growth, less multiple follicles, less multiple pregnancy, less OHSS and less coast. Than group A and B but had less ovulation rate and more in cancellation rate than group A and B.
Conclusion: We can offer ovulation induction and intrauterine insemination (IUI) for PCOS if first lines (lifestyle changes, pharmacotherapy (metformin, clomiphene citrate, letrozole, gonadotrophins) failed.