Therapeutic impact of letrozole and clomiphene citrate for ovulation induction in Iraqi female patients with polycystic ovary syndrome

Introduction: Clomiphene citrate (CC) is the most commonly used ovulation induction agent in women with polycystic ovary syndrome (PCOS). Letrozole has attracted attention for its ovulation induction effects as a safe, potentially better alternative to CC. The aim of this study was to compare the therapeutic efficacy of letrozole in comparison to CC for ovulation induction in female patients with PCOS in Baghdad Province, Iraq. Materials and Methods: A prospective, randomized, controlled study was carried out on 166 female patients diagnosed with anovulatory infertility due to PCOS and randomly assigned into two groups. Group A included ninety-four participants who received CC. Group B included 85 participants who received letrozole. The main outcomes were the ovulation induction and therapeutic outcomes of CC and letrozole, including endometrial thickness, number of mature follicles, pregnancy rate, number of stimulated cycles and mono-ovulation rate. Results: Endometrial thickness improved significantly more with CC than with letrozole (8.08 ± 1.28 vs. 7.66 ± 1.41; P = 0.05), as did the number of mature follicles (3.07 ± 1.23 vs. 1.97 ± 0.83; P = 0.0001). Nevertheless, Group B patients reported a higher significant rate compared to Group A regarding pregnancy rate (62% vs. 38%; P < 0.01), number of stimulated cycles (91% vs. 78%; P < 0.05), and mono-ovulation rate (29% vs. 5.75%; P = 0.0001). Conclusion: Letrozole is preferable to CC in terms of a higher pregnancy rate as well as mono-follicles' ability to decrease the risk of multiple pregnancies, which is clearly observed with CC. The higher success of letrozole over CC is thought to be related to the higher ovulation rate per cycle. The following core competencies are addressed in this article: Patient care and procedural skills, medical knowledge.