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Polycystic ovary syndrome (PCOS) is one of the most common endocrine pathologies and is a frequent cause of anovulatory infertility affecting 5 to 8% of reproductive-age women. The main syndromes of PCOS are chronic anovulation, hyperandrogenism, obesity, hypertension, diabetes mellitus type 2, and insulin resistance.
Currently, the most frequently administered therapeutic treatments in patients with C/C-resistant PCOS include gonadotropin, laparoscopic ovarian drilling (LOD), and aromatase inhibitors.
The main benefits of LOD are the shorter time to pregnancy and less need for ovulation induction drugs. Also, there’re disadvantages of LOD, as it requires hospitalization and general anesthesia and may lead to pelvic adhesions
Letrozole (LE), an orally active, reversible, nonsteroidal aromatase inhibitor, has good potential for inducing ovulation in women with PCOS without exerting anti-estrogenic effects on the endometrium.
This study aimed to compare the reproductive outcomes of laparoscopic ovarian drilling with LE in women with clomiphene citrate resistant PCOS.
This randomized controlled study was conducted at Ain Shams Maternity hospital and infertility clinic in the period between March 2017 and December 2018. It included 90 patients with clomiphene resistant PCOS divided into 2 groups, group A (45 patients) received LE 2.5 mg twice daily from day 2 of the menstrual cycle for 5 days for 3 successive cycles, while group B (45patients) underwent laparoscopic ovarian drilling, followed up for 3 successive cycles.
Regarding age and BMI, the study showed no statistically significant difference between the two studied groups with P-value 0.623 & 0.085 respectively. Also, regarding the hormonal profile of the two studied groups showed no statistical difference between the two groups as regard FSH, prolactin, TSH, free testosterone, LH, and E2 levels
As regards ovulation rate, this study showed no statistical difference between the 2 groups, although it was relatively higher in group A than group B (39.5%, 36.6% respectively with P-value 0.657).
In the current study, comparison of the endometrial thickness revealed no statistical difference between the two groups when measured on day 10 and day 12 with p-value 0.442, 0.598 respectively. While endometrial thickness measured on day 14 was higher in the LE group than in the LOD group, showing a significant statistical difference between the two groups (p-value 0.039). This significance concurred with the majority of studies that commented on the effect of LE on endometrial thickness when used for ovulation induction.
In agreement with most recent studies, our study showed a non-statistically significant relation between two studied groups regards biochemical pregnancy, clinical pregnancy, spontaneous abortion, and twin pregnancy rates with P-value 0.179,0.186, 0.627, and 0.157 respectively.
In concurrent with other studies our present study showed lower rates of women suffered from different side effects of intervention in group A than group B which denoting that LE was better than LOD in clomiphene resistant PCOS women. Noteworthy that side effects of LOD were linked to the procedure done once, while side effects of LE intake were cyclically repeated.
Considering financial issues, the cost of receiving LE was significantly lower than undergoing LOD. This has been highlighted in the recent study.
LE was generally well tolerated. Therefore, the results of the study indicate that LE might be an alternative to LOD in the treatment of CC-resistant PCOS.