Articles
Comparative efficacy of letrozole versus letrozole-metformin in the ovulation and clinical pregnancy rate in polycystic ovary syndrome: a prospective randomized controlled study
ABSTRACT
Objectives. The study provides an insight on the effect of letrozole and letrozole-metformin combination on the formation of mature follicle, ovulation, endometrial thickness and pregnancy rates in anovulatory PCOS infertile women.
Materials and Methods. A prospective randomised controlled study conducted at Ridge IVF centre, Delhi from May 2024-April 2025.120 women of ages 21-40 years affected by PCOS and trying naturally for conception were included. Patients were randomly selected into 2 groups: Group A -letrozole and metformin and Group B- letrozole only.
Metformin 500 mg twice daily was added from day 1 of cycle. Letrozole 2.5 mg BD was started from day 2/3 of menstrual cycle. Follicular monitoring was done from day 10 by transvaginal sonography and once a mature follicle of size > 18mm is seen on TVS, inj. HCG 10,000 IU was given. Once ovulation was documented, couple was advised for alternate day intercourse and luteal phase support was given for 14 days. Pregnancy confirmation was done by S. ß hcg after 14 days.
Results. The study showed that the formation of mature follicle was more in letrozole-metformin group and ovulation rate was higher in letrozole only group. The endometrial thickness on the day of the trigger was comparable in both groups. The clinical pregnancy was slightly higher in combination group, but not statistically significant.
Conclusions. Adding metformin to letrozole does insignificant improvement in ovulation patterns in PCOS anovulatory women.
Key words
PCOS; letrozole; metformin; ovulation
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