Comparing the effect of gonadotropin versus letrozole for induction of ovulation in patients with polycystic ovary syndrome with clomiphene citrate failure

Background and aim Polycystic ovary syndrome (PCOS) is an endocrinopathy affecting women during the childbearing period, with incidences of between 8 and 13%. PCOS is the main cause of anovulatory infertility with a prevalence of 20% in infertile women. We aimed to compare the ovulation induction effect of letrozole versus gonadotropins in patients with PCOS after clomiphene citrate (CC) failure. Patients and methods This is a prospective comparative study held in the El Hussien University Hospital, Al-Azhar University; throughout the duration of 12 months from January 2020 to January 2021. In all, 100 women were enrolled in the study diagnosed with PCOS with an ovulatory infertility and after CC failure, patients were allocated into two groups in a ratio of 1 : 1. The first group included 50 patients and received (letrozole 2.5 mg tablet) twice daily. Results There was higher incidence of confirmed ovulation in the gonadotropin group (62%) compared with the letrozole group (58%) with no significance. It also showed a higher incidence of confirmed pregnancy in the gonadotropin group (34%) compared with the letrozole group (30%), but that difference was statistically nonsignificant. The results showed a shorter duration till the day of trigger in the letrozole group (13.48) compared with the gonadotropin group (14.55), the difference was significant. Endometrial thickness on day of trigger was higher in the gonadotropin group (11.3) compared with the letrozole group (10.9) with no significance. Conclusion In patients who failed to conceive with CC, gonadotropins have higher pregnancy rates for ovulation induction than letrozole with an insignificant statistical difference.