Volume : 8, Issue : 3, March - 2019

A STUDY TO COMPARE THE EFFECTS OF LETROZOLE AND CLOMIPHENE CITRATE ON LIVE BIRTH RATE IN INFERTILE WOMEN WITH POLYCYSTIC OVARIAN SYNDROME (PCOS) UNDERGOING INTRAUTERINE INSEMINATION

Sabahat Rasool, Ruta Deshmukh, Omar S Akhtar, Sanam Rasool, Duru Shah

Abstract :

INTRODUCTION In patients suffering from Polycystic Ovarian Syndrome (PCOS) Clomiphene Citrate (CC) has been used for the past 50 years as the first line of drug for ovulation induction (1). But it binds and blocks estrogen receptors and exerts antiestrogenic effect on the endometrium and cervical mucus which adversely affects the pregnancy rate. Letrozole does not block the estrogen receptors and thus has no antagonistic effect on endometrium(2). Letrozole is also associated with monofollicular growth and ovulation thus preventing complications like hyperstimulation and multiple pregnancies(2,3) . AIM This study was done to compare the effect of letrozole and CC on parameters related to ovulation, pregnancy rate and live birth rate in infertile women with PCOS undergoing intrauterine insemination (IUI). MATERIALS AND METHODS A retrospective analysis of the effect of CC and letrozole on the cycle characteristics and outcome of PCOS women undergoing ovulation induction was done at Gynaecworld, Mumbai, a centre of women’s health and fertility. One hundred primary infertility patients with PCOS were evaluated in this study and divided into CC (Group A, n = 50) and Letrozole (Group B n = 50). Group A received 100 mg of CC and Group B 5mg of Letrozole per day from day 3 to day 7 of menses. In both groups transvaginal sonography was done on day 2 of the cycle (baseline), followed by follicular monitoring till ovulation. Number of follicles, endometrial thickness, pregnancy rate, abortion rate and live birth rate were compared between the two groups. RESULTS The mean age in group A was 31.2 years and 29.9 years in group B (p=0.1025). There was no significant difference between the basal levels of FSH and LH between the two groups. BMI, Antral Follicle Count (AFC), and ovarian volume in both the groups were comparable. Letrozole group showed lower preovulatory estrogen levels as compared to that of clomiphene group which was statistically significant (p=0.0004). The difference in endometrial thickness and pregnancy rates were statistically significant, with group A having a lower pregnancy rate (P=0.012, P=0.032, respectively). There was no abortion in group A and 2 abortions in group B. CONCLUSION Our study shows that letrozole was associated with monofollicular growth, better endometrial thickness and pregnancy rates in infertile women with PCOS compared to clomiphene citrate. However, the live birth rates in letrozole and CC groups were not statistically significantly different.