Comparison of pregnant and non-pregnant women with clomiphene resistant polycystic ovary syndrome in treatment with metformin and letrozole

ABSTRACT

Polycystic ovary syndrome [PCOS] is one of the most common causes of anovulatory infertility. Clomiphen citrate [CC] is the first line therapy for women with infertility and PCOS. These patients usually respond to clomiphene citrate in doses between 50-100 mg/day. However, failure of the patient to respond to a dosage of 150 mg/day of clomiphene citrate is considered as clomiphene resistant. The aim of this study was to compare between pregnant and non-pregnant women in cases of PCOS patients with CC resistant. Meanwhile, we evaluated ovulatory rate, pregnancy rate and live birth rates. We studied 106 CC-resistant PCOS patients who attended to Amir-Al-Momenin Hospital [Semnan, Iran] during the years 2005-2008. After an initial 6-8 weeks of metformin [1500mg daily 500mg q8h], they received 2.5mg letrozole for 5 days starting on cycle day 3. If they failed to show ovluation with 2.5mg letrozole, doses were increased to 5 and 7.5 mg daily in the subsequent cycles. One patient developed generalized rash with metformin and excluded from the study. 14 of 105 patients [13.33%] conceived with metformin alone. Overall, ovulation rate was 83.91 [91.2%]. Overall, pregnancy rate was 60/105 [57.14%] with 45 [74.9%] full term pregnancies, 10 [16.7%] abortions and 5 [8.3%] preterm births. The only significant difference between the responder and non-responder was found in the age of patients [P=0.008]. No significant differences were found in BMI, period of infertility, menstrual pattern, hirsutism, pictures of PCO in one or two ovaries in sonography, LH, and FSH or LH/FSH ratio. Combination of metformin with incremental doses of letrozole associated with a good pregnancy rate in CC-resistant PCOS patients. The treatment seems especially more effective in young weman