EJMS

Abstract

Background: Polycystic ovary syndrome (PCOS) is the major cause of anovulatory infertility. Clomiphene citrate (CC) and Letrozole can be used for ovulation induction but the later has several advantage over the former. The most favorable dose of Letrozole for ovulation induction in PCOS patients has not been determined. Objective: Was to compare between the step up and conventional protocols of Letrozole in ovulation induction. Patients and methods: Current prospective comparative study consisting of 90 Egyptian patients diagnosed as having infertility with PCOS. Patients were randomized divided into two equal groups: Conventional group: included 45 females taking Letrozole 5 mg tablet orally once daily started on day 3 to day 7 of menstrual cycle, and Step-up Group: included 45 females taking Letrozole 5 mg tablet in a step-up protocol 5mg in day one, 7.5 in day 2, 10 in days 3, 12.5 in day 4 & 15 in day 5 started on day 3 to day 7 of menstrual cycle. Main outcome measures: The primary outcome measures were the number and size of follicles as well as endometrial thickness, ovulation and pregnancy rates. Results: The mean age and duration of infertility in both groups were similar. There was no significant difference in the endometrial thickness (9.87±1.58 vs 10.00±1.87 mm), the number of mature follicles (1.74±0.66 vs 1.84±0.65), size of mature follicles (19.48±2.60 vs 20.57±2.74) in conventional and step-up groups, respectively. Ovulation occurred in 69.8 and 78.6% of patients in conventional and step-up groups, respectively without a statistically significant difference. The pregnancy rate per first ovulatory cycle was 81.4% in conventional group and 78.6% in step-up group without significant difference. No adverse effects of Letrozole was observed in either group. Conclusion: Although, there was a higher endometrial thickness, ovulation rate and pregnancy rate in step-up protocol but this difference was insignificant.