Letrozole With or Without Gonadotropin as a First-Line Ovulation Induction in Anovulatory Infertile Women Due to Polycystic Ovary Syndrome

Abstract

Objectives: The objective is to evaluate the clinical outcome of using letrozole alone or with gonadotropin as first-line ovulation induction in anovulatory infertile polycystic ovary women. Methods: A prospective single-arm study. 80 infertile polycystic ovarian syndrome (PCOS) women had been recruited between January and October 2017. Letrozole on day 2–3 of the cycle was given. The women are sorted into two groups according to the size of the dominant follicle on day 7 or 8, Group A (letrozole only group) and Group B (letrozole plus gonadotropin).Results: In our study, the overall pregnancy rate was (67.5%) and ovulation rate was 91.3%. The ovulation rate was significantly higher in Subgroup A than B (97.9% vs. 81.3%). Pregnancy rate was higher in Subgroup A (72.9% vs. 59.4%), but it was statistically not significant. The number of follicles was significantly higher in Subgroup B. Endometrial thickness, miscarriages, ovarian hyperstimulation syndrome, and multiple pregnancies were not statistically significant. Lower cycle number independently and significantly predict clinical pregnancy, while body mass index has a modest effect.Conclusions: Letrozole alone or in combination with gonadotropin as a first-line treatment in PCOS may be reasonable since this approach may improve the success rate and minimize the overall costs and risks.

Effects of letrozole alone or letrozole in combination with low-dose intramuscular injection of human menopausal gonadotropin on ovulation and pregnancy of 150 patients with polycystic ovary syndrome

“…35 The observations in our study were, however, comparable to those seen in a study by Zhihua Chen et al and Fadia J Alizzi, who found the pregnancy rates of LE+HMG group to be 55.7% and 59.4%, respectively. 36,37 In our study, the maximum follicular size in group A was 19.3±1.2 mm while in group B, it was 18.83±1.17 mm, the difference between the two groups being statistically insignificant. However, the number of mature follicles per cycle was higher in group B (2.1±1.3) as compared to group A (1.14±0.8), the difference between the two being highly significant statistically (p-value<0.001).…”

Predictors for Response to Letrozole as an Ovulation Induction in Anovulatory Infertile Polycystic Ovarian Syndrome Women

“…The primary outcome measure for letrozole as an OI in the study shows that the overall clinical response in the form of ovulation and pregnancy was 64.2% and 32.8%, respectively, and these results were lower than those seen in other studies (Alizzi FJ [11] , Amer, et al [22] , Palomba, et al [23] ). The lower ovulation and pregnancy rate seen could be due to the and clomiphene resistant (37.3).…”

“…The majority of the studies done on letrozole were on patients with clomiphene resistance (Mitwally, et al [5] , Kamath, et al [6] , Quintero, et al [7] ), and because of its short history in this respect, concepts like letrozole resistance and failure were not addressed. As the first line of treatment, letrozole can be used because it is ovulation, pregnancy, and live birth rate are higher as well as lower multiple pregnancy rates, although the reluctance to adopt such new therapy is frequent in clinical practice (McCartney, et al [8] , Legro, et al [9] , Casper, RF [10] , Alizzi, FJ [11] ). Taken in considerations that the presence/ absence of all PCOS features whether clinical or biochemical will help the clinicians to manage these patients correctly and that the recognition of predictors of treatment response to OI is essential for the success of a therapy because their identification could lead clinicians to the best-individualized treatment to improve the efficacy of the therapy, while optimizing its safety profile (Rausch, et al [12] ).…”

Comparison between Letrozole with and without Gonadotropins Injection on Pregnancy Rates in Infertile PCOS Patients: A Multicenter Randomized Observational Trial

“…This requires re-establishing a state of balance in the synthesis of intra-ovarian hormones that between the two groups. Similarly, Alizzi, et al [27] reported no significance. On the other hand, Chen, et al [28] found that letrozole alone does not significantly reduce the thickness of the endometrium.…”