Comparison between criteria and outcome of induction ovulation cycle with letrozole combined FSH and letrozole combined HMG in infertile polycystic ovarian syndrome patients

Background: Polycystic ovary syndrome (PCOS) is the most common condition associated with chronic anovulation. Several meta-analyses have shown that the use of letrozole and gonadotropins may improve treatment results in clomiphene resistant infertile women. The aim of this study was to compare the efficacy of letrozole combined FSH and letrozole combined HMG in infertile polycystic ovarian syndrome patients.Methods: A number of 118 clomiphene-resistant PCOS patients who referred to Milad infertility center with normal TSH, PRL, spermogram and HSG were randomly divided into two groups: group 1 received Letrozole and HMG and group 2 received letrozole and Gonal-f (recombinant FSH). From day 10th follicles number and size and endometrial thickness were evaluated by transvaginal sonography. hCG was administered when at least one mature follicle (> 18mm) was observed and IUI was performed 36 h later. Vaginal suppository progesterone was used daily for luteal phase support. In this study, the treatment success was included positive pregnancy test and gestational sac and fetal heart activity seen through abdominal ultrasound. Women who conceived were followed through pregnancy up to delivery .Result: Both groups were similar in demographic charactristics. Paraclinical and clinical pregnancy rate were significantly higher in the group treated with letrozole and FSH (P = 0.041). In this study, abortion rate, full term live birth, multiple pregnancy,ovulation,the number of 11-13 mm ovarian follicles in gonadotropin administration day and 11-13 mm, 14-17 mm and greater than 18 mm follicle and endometrial thickness on the day of hCG administration and total dose of gonadotropin were compared at the significance level of (p> 0.05).Conclusion: Letrozole combined FSH is more effective than letrozole combined HMG for induction ovulation in clomiphene resistant PCOs patient due to higher rate of pregnancy

Keywords:

FSH , HMG , Ovulation induction , Pregnancy , PCOS