Comparison between the efficacy of combined the drugs: metformin – letrazole with metformin – clomiphene citrate in polycystic ovarian syndrome

BackGround: The combination of the drug: Metformin and the antiestrogen (clomiphene citrate) in clomiphene –resistant PCOS patients enhance the ovulatory response of those patients. Although there is anti-estrogenic effects of clomiphene, it may be also associated with lower pregnancy rate. Inaddition to the the ovulation rate benefit, Letrazole is acting as an "aromatase inhibitor" which increases the ovulation rate without antiestogenic side effects of estrogen. AIM OF STUDY: is to induce ovulation& increase the pregnancy rate and live birth rate in patient with PCOS using a new era of therapy with less side effects, less complications and better patient compliance. Materials and Methods: Our research study is a "single – blind randomized clinical trial" ,one hundred mensturual cycles were studied in sixty patients with clomiphene – resistance having PCOS.They were selected among 115 patients with PCOS attending our infertility clinic in Samawa city – Iraq during the years 2011 – 2012. The Infertile female patients with PCOS were habhazardly divided into Metformin –Letrazole group who are 29 patients, and Metformin – clomiphene groups who are30 patients following an initial 6 – 8 weeks of gradual metformin use .The patients were received either the drug "Letrazole" (5mg) in two divided doses from2nd to 7th day or atiestrogen "clomiphene citrate" (100mg in two divided doses)daily from 5th to 9th day of menstrualcycle .The hormone "Estradiol" (E2) level , follicular numbers and the thickness of endometrium were examined on the day of HCG injection .The pregnancy rate of both groups also estimated. Results : The estimation of total E2 and E2& their mean for each mature follicle were found to be significantly elevated in clomiphene group, and there is no significant difference in mean number of mature ovarian follicles ≥ 18mm and their ovulation rate . There was significant increment of endometrial thickness with patient with Letrazole group . Thenumber of patients getting pregnancy in Letrazole group ( 10patients , 34.50%) as compared with clomiphene group (5 patients 16.6%),which did not reflect significant difference , while full – term pregnancies rate were more in Letrazole group (10patients 34.5%) in comparisim to 3patients (10%). Conclusion : In clomiphene resistant PCOS patients , the addition of Letrazole to Metformin causes higher full term pregnancies as compared with the use of clomiphene and Metformin.