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Background: polycystic ovarian syndrome (PCOS) is a common cause of infertility and is associated with chronic anovulation and hyperandrogenemia. Clomiphene citrate (CC) is still the first-line therapy for ovulation induction in these patients. Metformin, a biguanide, has been used to treat insulin resistance in women with PCOS. Furthermore, many reports confirmed that the addition of metformin to CC in the CC-resistant PCOS was highly effective in achieving ovulation. Letrozole, an aromatase inhibitor, has attracted attention for a long time to induce ovulation. Aim of the work: In the current study, we aimed to compare the effect of administration of combined metformin– Clomiphene Citrate to that of combined metformin–letrozole in the induction of ovulation in infertile overweight women with PCOS. 40 infertile overweight cases with PCO were included. Methods: Sixty participants had received metformin in aggregate with both CC (100 mg) or and similar number received letrozole (5 mg) plus metformin for 5 days starting from 3rd day of their menstrual cycle. Results: The cumulative pregnancy rate CC-metformin was 21.66% and letrozole-metformin was 25%, the difference is insignificant. Conclusion: CC and letrozole are similarly viable in the treatment of overweight women with PCOS, when joined with metformin treatment. Running title CC plus metformin versus letrozole plus metformin in treating PCO

Clomiphene-Metformin in Comparison with Letrozole-Metformin in Overweight Infertile Women with PCOS