The Effectivenessof Letrozole Sequential With Clomi Phene Citrate For Ovulation Induction In Women With Polycystic Ovary Syndrome

[OBJECTIVE]Polycystic ovary syndrome(PCOS)is the most common endocrine disorderin women of reproductive age,and the main cause of anovulatory infertility.The clinical presentation of PCOS varies widely.The most common symptomsaremenstrual disturbances,clinical manifestationsofhyperandrogenismand infertility.The treatment for women with PCOS depends on the symptoms which a PCOS patient presents.For patients with fertility requerements,ovulation treatment is the most common therapy.Our findings compare LE sequential with CC and LE sequential HMG to evaluate the effectiveness of two groups for ovulation induction in women with polycystic ovary syndrome(PCOS).[METHODS]The study has been registered in Clinical trial.com.A total of 62 womens,72 cycle were included in the present study at the Department of Obstetrics and Gynecology between December 2015 and July 2016.All the steps of the study were explained to the patients and all participants provided their informed consent before their involvement in this study.All patients information remained confidential.The diagnosis of PCOS was based on the Rotterdam criteria which offered by European Society for Human Reproduction and Embryology(ESHRE)and American Society for Reproductive Medicine(ASRM)in 2003,in which at least two of the following three criteria were appears:oligomenorrhea or amenorrhea,clinical hyperandrogenism(such as hirsutism and acne)and/or hyperandrogenemia,and polycystic ovaries.The criteria for polycystic ovarian morphology includes the presence of 12 or more follicles measuring between 2 and 9 mm in diameter and/or an increased ovarian volume of greater than 10 ml.The patients were divided into two groups:letrozole sequential clomiphene citrate group and letrozole sequential human menopausal gonadotropin group.Letrozolesequential clomiphene group:patients received clomiphene citrate 100mg/d starting from day 11 and maintained for five days.Letrozole sequential HMG group:patients received human menopausal gonadotropin 75IU/d starting from day 11 and maintained for 12 days.ifno dominant follicle was detected after up to 12 days of therpy(cycle day 22),this was considered no response.Nosignificant differences were found inage,body mass index,mense,infertility years,basal follicle stimulating hormone,basal iuteinizing hormone,polycystic ovary,primary infertility between the two groups.The rate of monofollicular development,endometrial thickness at injecting HCG,immature follicles,ovulation,OHSS,clinical pregnancy,multiple pregnancies and duration of medication were compared between the two groups.The inclusion criteria included the following:PCOS women who were more than 20 and less than 38 years old;the patients’s follicle ≤10mm in day 11 after receiving letrozole 5.0mg starting from day 3 to day 7 of a spontaneous or progesterone-induced withdrawal of bleeding;a normal hysterosalpingogram or laparoscopy;male partners all had a normal semen analysis.Exclusion criteria were as follows:the patients who were more than 38 year old;the presence of infectious deseases and other endocrine diseases;the presence of any infertility factors other than anovulatory PCOS,such as hyperprolactinemia,hypothalamic amenorrhea,premature ovarian failure,and ovarian tumor.[RESULTS]1.In LE sequential with HMG group and LE sequential with CC group,the monofollicular development rate was 78.95%,88.24%;immature follicles rate was 2.94%,7.89%;ovulation rate was 89.47%,97.06%;OHSS rate was 5.26%,0%;clinical pregnancy rate was 10.53%,13.16%;multiple pregnancies was 5.26%,2.94%;all no significant differences(P>0.05).2.Endometrial thickness in LE sequential with CC group(9.13±2.32cm)was significant thicker than LE sequential with HMG group(10.27±1.92cm)(P<0.05).3.The duration of medication in LE sequential with CC group(10.00±0.00 days)was significant less than LE sequential with HMG group(12.16±1.98 days)(P<0.05).4.The cost in LE sequential with CC group was cheaper than LE sequential with HMG group.[CONCLUSIONS]LE sequential CC group and LE sequential HMG group can both obtain good effect of ovulation and pregnancy rate.The rate of OHSS has no obvious difference.The intrauterine membrane of HCG days is thinner and the duration of medication is less in LE sequential CC group.