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1 Department of Gynecology, Kurdistan Board of Medical Specialties, Erbil, Iraq. 2 Maternity Teaching Hospital, Erbil, Iraq. 3 Department of Obstetrics and Gynecology, College of Medicine, Hawler Medical University, Erbil, Iraq. * Correspondence: aryianadr@yahoo.com Introduction Anovulatory dysfunction is a common problem and is responsible for about 40% of female infertility. Clomiphene citrate is considered as the drug of choice for first line treatment of anovulatory dysfunction for a variety of reasons. It is orally administered, has few side effects, is readily available, and is inexpensive. Although ovulation rates are in the range of 70-80%, the actual pregnancy rates are significantly lower at around 30-40%. Clomiphene resistance, together with side effects like multi-follicular development and cyst formation, are areas of concern. The desire for an effective alternative persists. The need for an alternative to clomiphene citrate (CC) for ovulation induction (OI) was realized since the 1990s. CC had antiestrogenic effects on the endometrium on the cervical mucus and the prolonged accumulation in tissues leading to prolonged depletion of estrogen receptors. This could result in hot flushes, perimenopausalsymptoms. Letrozole, an aromatase inhibitor, was introduced into infertility practice in the year 2000 and is regarded as a second line treatment option, particularly in women with clomiphene resistance. Letrozole is an orally active third-generation aromatase inhibitor most commonly used for ovulation Background and objective: Ovulatory dysfunction is a common cause of infertility. This study aimed to determine if letrozole is more efficient than clomiphene for the induction of ovulation in a group of un ovulatory infertile women. Methods: A prospective, comparative study was conducted at the Fertility Center Out-patient Department of Maternity Teaching Hospital, Erbil city, Kurdistan Region, Iraq, from May 2011, to May 2012. Hundred infertile couples having anovulatory infertility were included in the study; 50 women (146 cycles) were given letrozole 5 mg for three cycles, and 50 (148 cycles) women were put on clomiphene citrate (CC) 100 mg for three cycles, from day 2 to day 6 of the menstrual cycle. The diagnosis of pregnancy was confirmed by ultrasound. Two-tailed independent t-test was used to compare means, while proportions were compared with the Chi-Square test. Results: Ovulation occurred in 131/150 women in the clomiphene citrate group and 124/150 women in the letrozole group. The total number of mature follicles for clomiphene citrate was 1.44 ±0.56mm, while it was 1.13 ±0.32mm for letrozole, which was highly significant (P = 0.001). Endometrial thickness at the time of hCG administration for clomiphene citrate versus letrozole was (7.95 ±1.53mm versus 9.37 ± 2.04mm, P = 0.001) respectively. The pregnancy rate was 16/148 cycles in the clomiphene citrate group and 20/146 cycles in the letrozole group. Conclusion: Letrozole and clomiphene citrate are equally effective for the induction of ovulation and achieving pregnancy in patients with anovulatory infertility.

Comparison of efficacy of letrozole and clomiphene citrate for induction of ovulation