Efficacy of combined letrozole-metformin in comparison with letrozole only in clomiphene resistant infertile women with polycystic ovarian syndrome: a randomized controlled trial
Keywords:
PCOS, Polycystic ovary syndrome, clomiphene resistant PCOSAbstract
The aim of the work is to compare and determine the efficacy of combined metformin-letrozole administration in comparison with letrozole only in ovulation induction and the reproductive outcome in clomiphene – resistant infertile women with PCOS.The sample was 80 Women with PCOS and clomiphene citrate resistance. This study sample was allocated into two groups group (1) that received letrozole plus metformin, and group (2) that received letrozole only. All participants were followed up for 6 cycles and during this period monitoring through transvaginal ultrasonography was done every other day from day 12 of the cycle to assess follicular growth,number of follicles and endometrial thickness until at least one follicle reach 18 mm or more or reaching day 18.HCG was administered to those in whom at least one ovarian follicle reached 18 mm or more in size. The study revealed that Ovulation was 43.68 % in group (1) and 31.69 % in group (2) but without significant differences between both groups. pregnancy occurred in 8 women in group (1) and in 5 women in group (2) (20 % vs. 12.5 %) with no statistically significant differences between the two groups.
Downloads
References
Abd Elgafor, I. (2013). Efficacy of combined metformin–letrozole in comparison with bilateral ovarian drilling in clomiphene-resistant infertile women with polycystic ovarian syndrome. Archives of Gynecology and Obstetrics, 288(1), 119-23.
Abu Hashim H. (2015): Predictors of success of laparoscopic ovarian drilling in women with polycystic ovary syndrome: an evidence-based approach. Archives of Gynecology and Obstetrics, 291(1), 11-8.
Brown, J., Farquhar, C., Beck, J., Boothroyd, C., & Hughes, E. (2009). Clomiphene and anti-oestrogens for ovulation induction in PCOS. Cochrane Database of Systematic Reviews, (4).
Casper, R. F., & Mitwally, M. F. (2011). Use of the aromatase inhibitor letrozole for ovulation induction in women with polycystic ovarian syndrome. Clinical Obstetrics and Gynecology, 54(4), 685-95.
Dasari, P., & Pranahita, G. K. (2009). The efficacy of metformin and clomiphene citrate combination compared with clomiphene citrate alone for ovulation induction in infertile patients with PCOS. Journal of Human Reproductive Sciences, 2(1), 18-22.
Davar, R., & Aflatoonian, A. (2004). The effect of letrozole in induction of ovulation in clomiphene resistant patients. International Journal of Reproductive BioMedicine, 2(2), 78-0.
Franks, S. (1995). Polycystic ovary syndrome. New England Journal of Medicine, 333(13), 853-61.
Hart, R., & Doherty, D. A. (2015). The potential implications of a PCOS diagnosis on a woman’s long-term health using data linkage. The Journal of Clinical Endocrinology & Metabolism, 100(3), 911-9.
Holzer, H., Casper, R., & Tulandi, T. (2006). A new era in ovulation induction. Fertility and Sterility, 85(2), 277-84.
Homburg, R. (2005). Clomiphene citrate—end of an era? A mini-review. Human Reproduction, 20(8), 2043-51.
Johnson NP. (2014): Metformin use in women with polycystic ovary syndrome. Annals of Translational Medicine, 2(6): 56.
Kar S. (2013): Current evidence supporting “letrozole” for ovulation induction. Journal of Human Reproductive Sciences, 6(2), 93 – 9.
Legro, R. S., Brzyski, R. G., Diamond, M. P., Coutifaris, C., Schlaff, W. D., Casson, P., ... & Zhang, H. (2014). Letrozole versus clomiphene for infertility in the polycystic ovary syndrome. New England Journal of Medicine, 371, 119-29.
Mitwally, M. F., & Casper, R. F. (2001). Use of an aromatase inhibitor for induction of ovulation in patients with an inadequate response to clomiphene citrate. Fertility and Sterility, 75(2), 305-9.
Naka, K. K., Kalantaridou, S. N., Kravariti, M., Bechlioulis, A., Kazakos, N., Calis, K. A., ... & Michalis, L. K. (2011). Effect of the insulin sensitizers metformin and pioglitazone on endothelial function in young women with polycystic ovary syndrome: a prospective randomized study. Fertility and sterility, 95(1), 203-9.
Nawrocka, J., & Starczewski, A. (2007). Effects of metformin treatment in women with polycystic ovary syndrome depends on insulin resistance. Gynecological Endocrinology, 23(4), 231-7.
Ndefo U, Eaton A and Green M. (2013): Polycystic Ovary Syndrome: A Review of Treatment Options With a Focus on Pharmacological Approaches. Pharmacy and Therapeutics, 38(6), 336 – 55.
Palomba, S. (2015). Aromatase inhibitors for ovulation induction. The Journal of Clinical Endocrinology & Metabolism, 100(5), 1742-7.
Rosenfield, R. L., & Ehrmann, D. A. (2016). The pathogenesis of polycystic ovary syndrome (PCOS): the hypothesis of PCOS as functional ovarian hyperandrogenism revisited. Endocrine Reviews, 37(5), 467-520.
Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. (2004): Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertility Sterility, 81(1), 19-25.
Sohrabvand, F., Ansari, S. H., & Bagheri, M. (2006). Efficacy of combined metformin–letrozole in comparison with metformin–clomiphene citrate in clomiphene-resistant infertile women with polycystic ovarian disease. Human Reproduction, 21(6), 1432-35.
Suryasa, I.W., Sudipa, I.N., Puspani, I.A.M., Netra, I.M. (2019). Translation procedure of happy emotion of english into indonesian in kṛṣṇa text. Journal of Language Teaching and Research, 10(4), 738–746
Waldman I and Legro R. (2019): Polycystic Ovary Syndrome. In Leung P and Adashi EY, editors: The Ovary. 3rd edition. Elsevier Inc, 415 – 35.
Young, S. L., Opsahl, M. S., & Fritz, M. A. (1999). Serum concentrations of enclomiphene and zuclomiphene across consecutive cycles of clomiphene citrate therapy in anovulatory infertile women. Fertility and Sterility, 71(4), 639-44.
Published
How to Cite
Issue
Section
Copyright (c) 2022 International journal of health sciences
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Articles published in the International Journal of Health Sciences (IJHS) are available under Creative Commons Attribution Non-Commercial No Derivatives Licence (CC BY-NC-ND 4.0). Authors retain copyright in their work and grant IJHS right of first publication under CC BY-NC-ND 4.0. Users have the right to read, download, copy, distribute, print, search, or link to the full texts of articles in this journal, and to use them for any other lawful purpose.
Articles published in IJHS can be copied, communicated and shared in their published form for non-commercial purposes provided full attribution is given to the author and the journal. Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in this journal.
This copyright notice applies to articles published in IJHS volumes 4 onwards. Please read about the copyright notices for previous volumes under Journal History.
