Publication:

Clinical research on the relative efficacy of letrozole and clomiphene citrate in achieving ovulation among women with polycystic ovarian syndrome

Background Polycystic ovarian syndrome (PCOS) is a leading cause of anovulatory infertility. PCOS is the most common cause of infrequent periods (oligomenorrhoea) and absence of periods (amenorrhoea). It affects about 4% to 8% of women worldwide and often leads to anovulatory subfertility. Clomiphene citrate (CC) has been widely used for ovulation induction but is limited by endometrial effects and resistance. Letrozole, an aromatase inhibitor, has emerged as an alternative with potentially superior efficacy. Aim of the study was to compare the efficacy of letrozole and CC in ovulation induction among women with PCOS.

Methods A prospective comparative study was conducted on 100 infertile women with PCOS aged 21–35 years at Government Peripheral Hospital, Tondiarpet, Chennai, from September 2024 to August 2025. Participants were allocated into two groups: letrozole (n=50) and clomiphene citrate (n=50). Follicular development and rupture were assessed by transvaginal ultrasonography. Statistical analysis was performed using statistical package for the social sciences (SPSS), with p<0.05 considered significant.

Results The mean age was 26.3±2.5 years. The mean follicle number was lower in the letrozole group (1.5±0.89) compared with clomiphene (2.54±1.69). The mean number of ruptured follicles was significantly lower with letrozole (0.96±0.64) compared with clomiphene (1.48±1.07). Letrozole demonstrated a safer monofollicular response, while clomiphene induced multifollicular development.

Conclusions Both agents are effective for ovulation induction. Letrozole offers a safer monofollicular profile with reduced risk of multiple gestations, making it preferable when minimizing multiple pregnancies is a priority.