Use of clomiphene or letrozole for treating women with polycystic ovary syndrome related subfertility in Hilla city

Background: Polycystic ovarian syndrome (PCOS) is a common endocrino-pathology characterized by oligo-ovulation or an ovulation, signs of androgen excess, and multiple small ovarian cysts. It is thought to be one of the leading causes of female sub-fertility. It has been estimated that PCOS affects 5–10% of females in reproductive age. Its etiology is complex and likely multi-factorial. The aim of this study was to evaluate the therapeutic effect of clomifene citrate (CC) compared to letrozole in the treatment of patients with sub-fertility secondary to PCOS.Patients and methods: Eighty five sub-fertile married women at reproductive age were involved in this study during their attendance to the Infertility center of Maternity and Pediatrics Teaching Hospital in Hilla city and those referred from hospital in Hilla city, Babylon Province, Iraq. Patients were collected depending on history and physical examination seeking for features of endocrine disorders, clinical signs of hyper-androgensim such as acne and hirsutism. At day two of menstrual cycle measurement of hormones including Follicle Stimulating Hormone (FSH), Luteinizing Hormone (LH), Prolactin, Testosterone and Thyroid Stimulating Hormone (TSH), also Fasting blood glucose (FBG) and LH/FSH ratio were done. On day 12 of menstrual cycle ultrasound examination was done trans-vaginally to detect the number and size of follicles. Patients were diagnosed as PCOS when they have at least two out of three of Rotterdam criteria. Then patients were divided into two groups. Group 1 include 45 patients (80 cycles) were treated with CC (50 mg twice daily for 5 days starting from day 2 of menstrual cycle) and group 2 include 40 patients (47 cycles) were treated with letrozole (5 mg daily for 5 days starting from day 2 of menstrual cycle). After treatment the outcome measured (size and number of mature follicles, mono-follicular cycles and endometrial thickness measured at day 12 of menstrual cycle and pregnancy rate) in CC group were compared to those in letrozole group.Results: The present study found that each of the percentages of cycles responded to the treatment (resulted in mature follicles ≥17 mm in size) (70.21% vs 41.25%) and the mean number of mature follicles (1.42 ± 0.66 vs. 1.15 ± 0.44) was significantly higher in letrozole treated group (p < 0.05). While the number of mono-follicular cycles (87.87% vs 63.63%) and the mean of endometrial thickness (ET) (9.68 ± 2.73 vs. 8.02 ± 1.24 mm) was significantly higher in CC treated group (p < 0.05). Also the pregnancy rate (per cycle) was higher in CC treated group (12.12% vs 9.09%) although there was no significant difference (p > 0.05).Conclusion: Letrozole was the better in comparison to CC in regard to responded cycles and mean number of mature follicles whereas regarding to endometrial thickness, mono-follicular cycles, and pregnancy rate (per cycle), CC was the better