Randomized controlled trial comparing letrozole with laparoscopic ovarian drilling in women with clomiphene citrate-resistant polycystic ovary syndrome

Abstract

The aim of the present study was to compare the reproductive outcomes of letrozole and laparoscopic ovarian drilling (LOD) in women with clomiphene citrate (CC)-resistant polycystic ovary syndrome (PCOS). A total of 141 women with CC-resistant PCOS were enrolled and randomly allocated into groups A and B. Group A (n=71) received 2.5 mg letrozole from days 5 to 10 of menses for up to six cycles, and group B (n=70) underwent LOD. A 6-month follow-up was performed. No statistically significant difference was found in the baseline clinical characteristics and the major serum hormone profiles, including luteinizing hormone, follicle-stimulating hormone, estradiol and free testosterone, between the two groups. Women receiving letrozole had a lower rate of spontaneous abortion (6.9 vs. 15.8%) and higher clinical pregnancy (40.8 vs. 27.1%) and live birth (38.0 vs. 22.9%) rates; however, the differences were not statistically significant. Letrozole had superior reproductive outcomes compared with LOD in women with CC-resistant PCOS; therefore, letrozole could be used as the first-line treatment for women with CC-resistant PCOS.

Keywords: laparoscopy; letrozole; ovulation induction; polycystic ovary syndrome.

Figure 1.

Pre-and post-treatment hormone levels in the two groups. (A) FSH levels, (B) LH levels and (C) LH/FSH ratios. *P<0.01 vs. pre-treatment. FSH, follicle-stimulating hormone; LH, luteinizing hormone; D3, day 3 of the menstrual cycle.

Figure 2.

(A) A synchronous cycle. The dominant follicle reached a mean diameter of 17 mm and the endometrium was in the late follicular phase, with increasing hypoechogenic texture between the triple hyperechogenic lines. (B) An unsynchronous cycle with an underdeveloped follicle and a pre-transformed endometrium.