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Comparison of the efficiency of clomiphene citrate and letrozole in combination with metformin in moderately obese clomiphene citrate - resistant polycystic ovarian syndrome patients

Bjelica Artur (Faculty of Medicine, Novi Sad + Clinical Center of Vojvodina, Department of Obstetrics and Gynecology, Novi Sad)
Trninić-Pjević Aleksandra (Faculty of Medicine, Novi Sad + Clinical Center of Vojvodina, Department of Obstetrics and Gynecology, Novi Sad)
Mladenović-Segedi Ljiljana (Faculty of Medicine, Novi Sad + Clinical Center of Vojvodina, Department of Obstetrics and Gynecology, Novi Sad)
Ćetković Nenad (Faculty of Medicine, Novi Sad + Clinical Center of Vojvodina, Department of Obstetrics and Gynecology, Novi Sad)
Petrović Đorđe (Faculty of Medicine, Novi Sad + Clinical Center of Vojvodina, Department of Obstetrics and Gynecology, Novi Sad)

Introduction. Polycystic ovary syndrome is the most common endocrinopathy in women of reproductiveage. Therapy for those who want to get pregnant involves ovulation induction using clomiphene citrate, metformin, letrozole and gonadotropins. Objective. The aim of the study was to compare the efficacy of combinations of clomiphene citrate-metformin and letrozole-metformin in obese patients who are resistant to clomiphene citrate alone. Methods. The investigation was conducted as a retrospective study involving 60 moderately obese patients with polycystic ovary syndrome. Thirty-one of them received the clomiphene citrate-metformin, and 29 letrozole-metformin therapy. Stimulation was carried out for the procedures of intrauterine insemination (IUI). Results. The age of patients, duration of infertility, and body mass index in both groups were similar. There was statistically significant difference in the thickness of the endometrium in favor of the group having the letrozole-metformin therapy (8.9 ± 1.7 mm) compared with the group receiving the clomiphene citrate-metformin treatment (6.3 ± 1.3 mm). The number of follicles was not statistically significantly different. Pregnancy rate in the first cycle of IUI in the clomiphene citrate group was 6.4%, and 17.2% in the letrozole group, which also was not statistically different. After the third IUI cycle, the pregnancy rate was significantly higher in the letrozole group (20.6%), while in the clomiphene citrate group it was (9.6%). Conclusion. This retrospective study demonstrated the advantages of the use of letrozole over clomiphene citrate in combination with metformin in moderately obese patients with polycystic ovary syndrome who are resistant to stimulation with clomiphene citrate alone.

Keywords: clomiphene citrate, letrozole, polycystic ovarian syndrome