Background: Polycystic ovarian syndrome (PCOS) is a disease which is responsible for  infertility in females, resulting from the interplay of genetic and environmental factors. Ovulation induction is crucial for PCOS patients seeking pregnancy. While clomiphene citrate (CC) has been a standard treatment, its resistance rates necessitate alternative strategies. Letrozole has emerged as a promising alternative, with higher success rates and lower risk of multiple pregnancies compared to CC. However, the efficacy of combining letrozole and CC in the same cycle remains underexplored.

 

Methodology: This study is a randomized control trial which was conducted at the Department of Obstetrics and Gynaecology, Lady Willingdon Hospital, Lahore. Fifty-six PCOS patients aged 19 to 35 seeking pregnancy were randomly distributed to two groups: Group A received letrozole alone (2.5 mg/day, days 5-9 of menstrual cycle) for three cycles. In contrast, Group B received letrozole plus CC for the same duration. Ovulation was monitored using transvaginal ultrasonography, and pregnancy outcomes were recorded.

 

Results: The combination therapy (Group B) resulted in a significantly higher pregnancy rate compared to letrozole alone (Group A) (67.9% vs. 32.1%, p = 0.007). Age and duration of marriage did not significantly differ between the groups. While the number of cycles required to achieve pregnancy did not differ significantly, Group B showed a trend toward achieving pregnancy earlier.

Conclusion: This research concluded that the combination of CC and letrozole has a more beneficial and effective role than letrozole alone in inducing ovulation among PCOS patients seeking pregnancy. This combined therapy offers a low-risk, cost-effective alternative for infertility treatment with higher rates of ovulation. Further studies should be conducted to evaluate the adverse effects and rate of live births associated with the combined use of  CC and letrozole.