Comparative Efficacy of Sequential Letrozole or Clomiphene Citrate with Human Menopausal Gonadotropins for Ovulation Induction in Clomiphene Citrate-resistant Polycystic Ovary Syndrome: A Randomized Controlled Trial

ARTICLEcombined with CC or letrozole when initial ovulation induction proves ineffective. [6][7]][8] Combining gonadotropins (FSH/hMG) with CC can reduce the dose needed for optimal ovarian stimulation, making treatment more cost-effective for women unresponsive to CC alone. 9Previous research at our institute has shown promising pregnancy rates of 21% with the combination of CC and hMG for ovulation induction IntroductIonInfertility affects approximately 8-125 million women worldwide.In India, the prevalence of infertility ranges between 4 and 17%, according to World Health Organization estimates. 1Polycystic ovary syndrome (PCOS) accounts for 90-95% of anovulatory infertility cases. 2 The primary approach to managing PCOS-related infertility focuses on lifestyle modifications, including a hypocaloric diet, exercise, and yoga.If these efforts are insufficient, pharmacological options such as clomiphene citrate, metformin, letrozole, and gonadotropins are commonly used to stimulate ovulation.In certain cases, combination therapies or laparoscopic ovarian drilling with cautery or laser may also be employed to encourage ovulation. 3,4lomiphene citrate (CC) has been used for ovulation induction for many years; however, it may adversely affect the endometrial lining and cervical mucus, contributing to treatment resistance in 20-25% of cases and a reduced pregnancy rate. 5For CC-resistant women, alternative options include gonadotropins, which can be used alone or sequentially with CC or letrozole.Higher pregnancy rates have been reported with gonadotropins, but with an increased risk of multiple pregnancies and ovarian hyperstimulation.As a result, human menopausal gonadotropin (hMG) is frequently