Efficacy of an Extended 10-day Letrozole Regimen Compared to the 5-day Regimen in Enhancing Ovulation in Infertile Women with Polycystic Ovary Syndrome: A Randomised Controlled Trial.

BACKGROUND

Polycystic ovary syndrome (PCOS) is a leading cause of anovulatory infertility. Letrozole is the first-line agent for ovulation induction; however, response to the standard 5-day regimen may be suboptimal in some women.

AIM: The aim is to compare the efficacy and safety of an extended 10-day letrozole regimen with the conventional 5-day regimen for ovulation induction in infertile women with PCOS.

SETTINGS AND

DESIGN

Prospective, open-label, parallel-group randomised controlled trial conducted at a tertiary care centre in North India.

MATERIALS AND

METHODS

Eighty infertile women with PCOS (Rotterdam criteria, 2003) were randomised to receive either letrozole 2.5 mg daily for 10 days or 5 days. Up to three ovulation induction cycles were allowed. Follicular monitoring was performed using transvaginal ultrasonography. Ovulation was triggered with human chorionic gonadotropin, followed by timed intercourse.

STATISTICAL ANALYSIS USED: Continuous variables were analysed using the t-test or Wilcoxon-Mann-Whitney U test. Categorical variables were compared using the Chi-square or Fisher's exact test. A P < 0.05 was considered statistically significant.

RESULTS

The 10-day regimen showed a significantly higher follicular response in the first cycle compared to the 5-day regimen (85.0% vs. 52.5%, P = 0.002). Dose escalation and gonadotropin use were significantly lower in the extended regimen group. No cases of ovarian hyperstimulation syndrome were reported. Pregnancy rates were comparable between groups.

CONCLUSION

The extended 10-day letrozole regimen significantly improves follicular response without increasing adverse outcomes and may improve cycle efficiency in women with PCOS.