Letrozole Versus Clomiphene Citrate Plus Metformin in the First Treatment of Infertility in Patients With Polycystic Ovarian Syndrome

The study will be in 200 patient diagnosed to have PCOS among those attending the Fertility Outpatient Clinic at the Women's Health Center, Assiut University Hospitals.

The present study was prospective randomized controlled trial conducted over a period of 3 years from 1st of January 2009 to 1st of January 2012, at the Women's Health Center, Assiut University hospital, Assiut, Egypt, after approval was received from the Ethics Committee of faculty of medicine , Assiut University. Women referred to the infertility clinic in women's health center were screened for PCO using Rotterdam consensus criteria for the diagnosis of PCOS. The patients who were newly diagnosed as PCO and not treated previously were invited to participate in our study. Written informed consent was obtained from each participant after an information sheet had been provided. The patients had the right to refuse participation in the study or to withdraw at any time without being denied their full regular clinical care. All personal information and medical data were confidential and were not made available to third parties. All participants met the Rotterdam consensus criteria for the diagnosis of PCOS. At admission, a thorough medical history was taken and all women underwent physical examination, which included anthropometric measurements and after spontaneous menstruation or progestin induced withdrawal bleeding, basal endocrine evaluation on day 3 of the cycle included measurement of the serum concentrations of luteinizing hormone (LH), follicle-stimulating hormone (FSH),thyroid stimulating hormone(TSH ) and prolactin. Then vaginal sonographic examination were done to measure endometrial thickness and exclude cases endometrial pathology or baseline ovarian cysts.

The participants were randomized to receive letrozole or clomiphene citrate plus metformin. Randomization was performed using a computer-generated random numbers table, and allocation concealment was achieved using serially numbered opaque envelopes that were only opened once the interventions were assigned.

In the letrozole group, the ovaries were stimulated using 2.5mg/day letrozole (Femara; Novartis Pharma, Basel, Switzerland) for 5 days,in the form of one tablet( 2.5 mg) per day for 5 days from day 3 to day 7 of the menstrual cycle and if ovulation has occurred with no pregnancy continue on the same dose for another 2 consecutive cycles ,but if no ovulation increase the dose to 2 tablets per day(5 mg) for another 2 consecutive cycles in the same manner .

The patients in the second group will take metformin (Cidophage tablets,500 mg per tablet; CID, ARE, in an oral dose of 1,500 mg/d) 500mg three times daily for 3 months Plus clomid(50-mg tablets twice daily; Global Napi Pharmaceuticals, Cairo, Egypt , Arab Republic of Egypt) In the form of 50 mg twice daily (100mg /day) for 5 days from day 3 to day 7 of menstrual cycle and to be repeated for 3 consecutive cycles in the same manner if no pregnancy occur.