الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 110 |  |  |
| | | from | 110 | | |
Abstract
Review of literature and Introduction:
Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age, with an incidence of 5–10% PCOS manifestations range from mild menstrual irregularities to severe endocrine and reproductive dysfunction.
Among women with anovulatory infertility, PCOS accounts for nearly 80 % of the cases and affects approximately 20 % of couples trying to conceive.
Clomiphene citrate (CC) is the first drug used to induce ovulation in patients with PCOS. Although 70–80% of such women ovulate when treated with CC, only 40% become pregnant. Women who do not ovulate with increasing doses of CC are CC-resistant.
Letrozole is an orally active aromatase inhibitor that blocks the conversion of androgens to oestrogens, reducing the oestrogen levels and releasing the pituitary from negative feedback: this increases endogenous FSH production. In addition, letrozole amplifies FSH receptor gene expression, increasing follicular sensitivity to FSH.
Gonadotropins have been used for ovulation induction in CC-resistant patients with PCOS, and controlled administration of exogenous follicle stimulating hormone (FSH) induces and maintains the growth of follicles with fertile oocytes. Gonadotropins risk multiple follicular development, with a subsequent increased risk of ovarian hyperstimulation syndrome (OHSS) and multiple pregnancy.
Patients and methods:
The present study is a randomized clinical trial. The study was conducted at infertility clinic of Minia general hospital, Minia, Egypt; throughout the duration of 18 months from January 2017 to June 2018.
All patients were confirmed to have CC resistance defined as failure to ovulate after receiving 150 mg of CC daily for 5 days per cycle, for at least three cycles.
150 eligible patients were randomized into two group the first group received letrozole 2.5 tablets twice daily for five days starting at third day of spontaneous menstrual cycle or progesterone induced withdrawal bleeding the second group received gonadotropin hormones in the form of highly purified FSH with a starting dose of 75-150 IU according to BMI , age and previous exposure given intramuscular in day three of spontaneous menstrual cycle or progesterone induced withdrawal bleeding ,another TVUS was performed on day seven and repeated dose adjustment of gonadotropins in the form of 75-150 (IU) – maximum dose of 300IU/cycle – may be required according to the ovarian response
Both groups underwent transvaginal ultrasound scan (TVUS) /48 to asses ovarian maturation with a leading follicle >17 mm, when ovarian maturation was confirmed human chorionic gonadotropin (HCG) 10,000IU was given for triggering of ovulation.
Quantitave β-human chorionic gonadotrophin (β-hcg) was measured on day 14 after triggering and patient considered pregnant if serum level is >50 mIU/ml.
Results:
There was a non-significance difference (P>0.05) between the two groups as regards Age, BMI, Duration of infertility, Type of infertility and Previous ovarian drilling.
The results of this study showed a statistically significant higher incidence of confirmed ovulation in letrozole group compared to gonadotropin group. For letrozole group incidence of confirmed ovulation was 82.67% compared to 66.67% for gonadotropin group with P value of 0.024.
The average number of cycles needed to achieve ovulation was lower in letrozole group (1.95) compared to (2.98) for gonadotropin group with a P value less than (0.001).
The incidence of confirmed pregnancy was higher in letrozole group 18.67% compared to 13.34% for gonadotropin group however the difference was statistically non-significant P value 0.37.
The number of cycles needed to achieve pregnancy was lower in letrozole group 2.41 compared to 3.25 for gonadotropin group with a significant P value of 0.018.
The cost of ovulation induction medication per cycle was significantly lower in letrozole group 185LE/cycle compared to 410LE/cycle for gonadotropin group.