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Hum. Reprod. Advance Access originally published online on February 14, 2006
Human Reproduction 2006 21(6):1432-1435; doi:10.1093/humrep/del020
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© The Author 2006. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Efficacy of combined metformin–letrozole in comparison with metformin–clomiphene citrate in clomiphene-resistant infertile women with polycystic ovarian disease

F. Sohrabvand1, Sh. Ansari and M. Bagheri

Department of Infertility & IVF, Vali-e-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran

1 To whom correspondence should be addressed at: Department of Infertility & IVF, Vali-e-Asr Reproductive Health Research Center, Vali-e-Asr Hospital, Tehran University of Medical Sciences, Keshavarz Blvd., PO Box:14194, Tehran, Iran. E-mail: fsohrabvand{at}yahoo.com

BACKGROUND: Adding metformin to clomiphene citrate in clomiphene-resistant polycystic ovary syndrome (PCOS) patients increases ovulatory response. However, because of anti-estrogenic effects of clomiphene it may be associated with lower pregnancy rate, offsetting the ovulation rate benefit. Letrozole is an aromatase inhibitor which induces ovulation without anti-estrogenic effects. METHODS: Infertile women with PCOS were randomly divided into metformin–letrozole (29 patients) and metformin–clomiphene groups (30 patients). After an initial 6–8 weeks of metformin, they received either letrozole (2.5 mg) or clomiphene (100 mg) from day 3–7 of their menstrual cycle. Estradiol (E2) levels, number of follicles, pregnancy rates and endometrial thickness were measured on the day of HCG administration. RESULTS: Mean total E2 and E2 per mature follicle were significantly higher in clomiphene group without a difference in mean number of mature follicles >18 mm and ovulation rate. Endometrial thickness was significantly higher in letrozole group. The pregnancy rate in letrozole group (10 patients, 34.50%) as compared with clomiphene group (5 patients, 16.67%) did not show significant difference, whereas full-term pregnancies were higher in letrozole group [10 patients (34.50%) versus 3 patients (10%)]. CONCLUSION: In clomiphene-resistant PCOS patients, the combination of letrozole and metformin leads to higher full-term pregnancies.

Key words: clomiphene citrate/letrozole/metformin/PCOS/pregnancy rate


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