A Letrozole Versus Combined Letrozole-Metformin: Effect on Ovulation and Conception Rate in Women with Polycystic Ovarian Syndrome

  • Shabana Kalsoom WMC
  • Ruqqaiya Azhar WMC
  • Noreen Majeed
  • Mehreen Mehdi
  • Khairunnisa
  • Sidra Khan



Objective: To compare the efficacy of letrozole with combined letrozole-metformin in terms of ovulation rate and conception rate in overweight and obese subfertile women with polycystic ovarian syndrome.

Study design: Prospective randomized clinical trial

Material and methods: The study included 150 overweight and obese subfertile women with polycystic ovarian syndrome, who attended the outpatient department of POF hospital between 1st Feb 2019 to 31st Jan 2022.The participants were randomly divided into group A and B, 75 in each group. Women in group A were given letrozole 2.5 mg twice daily from day 2-6 of menstrual cycle.  In addition to letrozole the patients in group B were also given tablet metformin 500mg three times daily with meals throughout the cycle starting from the first day. The women were followed up regularly and treatment continued until the patient conceived or for 3 cycles. The sociodemographic details, ovulation rate, conception rate and side effects were noted on a proforma and analyzed by SPSS version 20.

Results: The cumulative ovulation rate was 84% with letrozole and 93.3% with letrozole metformin (p=0.071). The cumulative conception rate was 34.6% with letrozole and 47% with letrozole-metformin (p=0.135). The metformin was well tolerated without a significant increase in side effects.

Conclusion: As compared with letrozole alone, letrozole-metformin combination was associated with a higher ovulation and conception rate but the difference was not significant statistically.

Key words: letrozole, metformin, PCOS, ovulation rate, conception rate

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