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CC is the most commonly used drug for the induction and augmentation of ovulation in PCOS. However, 20 to 25% patients with PCOS are resistant to CC3 and fail to develop follicles of desired size.4 In addition, clinical data reveal a discrepancy between ovulation and conception rates between CC treatment, and a higher than expected incidence of miscarriage in conception cycles. These observations have been attributed to the peripheral antiestrogenic mechanism of action of CC that involves long lasting estrogen receptor depletion in the endometrium and cervix.2,3 Letrozole belongs to a new group of very potent, nonsteroidal, selective reversible third generation aromatase inhibitor developed for postmenopausal breast cancer therapy. Letrozole generally mimics the action of CC without depletion of estrogen receptors when administered early in the menstrual cycle.2 Because of the much shorter life span (45 hours) and absence of estrogen receptor binding, it possibly avoids the antiestrogenic effects associated with CC.2,3,5,16-18 INTRODUCTION

Letrozole for Induction of Ovulation in PCOS Patients: Resistant to Clomiphene Citrate