Abstract
Purpose
To compare the effect of letrozole with laparoscopic ovarian diathermy (LOD) for ovulation induction in clomiphene citrate (CC) resistant women with polycystic ovary syndrome (PCOS).
Methods
Two hundred and sixty anovulatory women with CC-resistant PCOS were selected in this randomized controlled trial. Group A (n = 128) received 2.5 mg letrozole daily for 5 days for up to six cycles. Group B (n = 132) underwent LOD with 6 months follow-up. Outcome measures were ovulation rate, midcycle endometrial thickness, pregnancy, miscarriage and live birth rates.
Results
Ovulation occurred in 335/512 cycles (65.4%) in letrozole group and 364/525 cycles (69.3%) in LOD group without significant difference between both groups. Resumption of regular menstruation was similar in both treatment groups. A significant increase in midcycle endometrial thickness was observed in letrozole group (8.8 ± 1.1 mm vs. 7.9 ± 1.2 mm) (P < 0.05). Pregnancy rate was similar in both groups (15.6 vs. 17.5%). There were no statistical significant differences as regards miscarriage and live birth rates between both groups. No multiple pregnancy or ovarian hyperstimulation occurred in either group.
Conclusion
Letrozole and LOD are equally effective for inducing ovulation and achieving pregnancy in CC-resistant PCOS patients.
Similar content being viewed by others
Change history
31 March 2023
This article has been retracted. Please see the Retraction Notice for more detail: https://doi.org/10.1007/s00404-023-07024-6
References
Azziz R, Woods KS, Reyna R, Key TJ, Knochenhauer ES, Yildiz BO (2004) The prevalence and features of the polycystic ovary syndrome in an unselected population. J Clin Endocrinol Metab 89:2745–2749. doi:10.1210/jc.2003-032046
Brown J, Farquhar C, Beck J, Boothroyd C, Hughes E (2009) Clomiphene and anti-oestrogens for ovulation induction in PCOS. Cochrane Database Syst Rev 4:CD002249
Thessaloniki ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group (2008) Consensus on infertility treatment related to polycystic ovary syndrome. Fertil Steril 89:505–522. doi:10.1016/j.fertnstert.2007.09.041
Randall JM, Templeton A (1991) Cervical mucus score and in vitro sperm mucus interaction in spontaneous and CC citrate cycles. Fertil Steril 56:465–468
Opsahl MS, Robins ED, O’Connor DM, Scott RT, Fritz MA (1996) Characteristics of gonadotropin response, follicular development, and endometrial growth and maturation across consecutive cycles of clomiphene citrate treatment. Fertil Steril 66:533–539
Nakamura Y, Ono M, Yoshida Y, Sugino N, Ueda K, Kato H (1997) Effects of CC on the endometrial thickness and echogenic pattern of the endometrium. Fertil Steril 67:256–260. doi:10.1016/S0015-0282(97)81907-3
National Collaborating Centre for Women’s and Children’s Health/National Institue for Clinical Excellence (2004) Fertility: assessment and treatment for people with fertility problems. Clinical Guideline No.11. RCOG Press, London. http://www.nice.org.uk/nicemedia/pdf/CG011niceguideline.pdf
Farquhar CM, Williamson K, Gudex G, Johnson NP, Garland J, Sadler L (2002) A randomized controlled trial of laparoscopic ovarian diathermy versus gonadotropin therapy for women with clomiphene citrate resistant polycystic ovary syndrome. Fertil Steril 78:404–411. doi:10.1016/S0015-0282(02)03225-9
Farquhar C, Lilford RJ, Marjoribanks J, Vandekerckhove P (2007) Laparoscopic ‘drilling’ by diathermy or laser for ovulation induction in anovulatory polycystic ovary syndrome. Cochrane Database Syst Rev 3:CD001122
Bayram N, van Wely M, Kaaijk EM, Bossuyt PM, van der Veen F (2004) Using an electrocautery strategy or recombinant follicle stimulating hormone to induce ovulation in polycystic ovary syndrome: randomised controlled trial. BMJ 328:192. doi:10.1136/bmj.328.7433.192
Felemban A, Lin Tan S, Tulandi T (2000) Laparoscopic treatment of polycystic ovaries with insulated needle cautery: a reappraisal. Fertil Steril 73:266–269. doi:10.1016/S0015-0282(99)00534-8
Holzer H, Casper R, Tulandi T (2006) A new era in ovulation induction. Fertil Steril 85:277–284. doi:10.1016/j.fertnstert.2005.05.078
Elnashar A, Fouad H, Eldosoky M, Saeid N (2006) Letrozole induction of ovulation in women with clomiphene citrate resistant polycystic ovary syndrome may not depend on the period of infertility, the body mass index, or the luteinizing hormone/follicle-stimulating hormone ratio. Fertil Steril 85:511–513. doi:10.1016/j.fertnstert.2005.08.016
Mitwally FM, Casper RF (2001) Use of an aromatase inhibitor for induction of ovulation in patients with an inadequate response to clomiphene citrate. Fertil Steril 75:305–309. doi:10.1016/S0015-0282(00)01705-2
Al-Omari WR, Sulaiman W, Al-Hadithi N (2004) Comparison of two aromatase inhibitors in women with clomiphene-resistant polycystic ovary syndrome. Int J Gynaecol Obstet 85:289–291. doi:10.1016/j.ijgo.2003.11.010
Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group (2004) Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril 81:19–25. doi:10.1016/j.fertnstert.2003.10.004
Organization World Health (1999) WHO laboratory manual for the examination of human semen and sperm-cervical mucus interactions, 4th edn. Cambridge University Press, Cambridge
Casper RF, Mitwally MF (2006) Review: aromatase inhibitors for ovulation induction. J Clin Endocrinol Metab 91:760–771. doi:10.1210/jc.2005-1923
Homburg R (2008) Oral agents for ovulation induction—clomiphene citrate versus aromatase inhibitors. Hum Fertil (Camb) 11:17–22. doi:10.1080/14647270701689670
Bayar U, Basaran M, Kiran S, Coskun A, Gezer S (2006) Use of an aromatase inhibitor in patients with polycystic ovary syndrome: a prospective randomized trial. Fertil Steril 86:1447–1451. doi:10.1016/j.fertnstert.2006.04.026
Badawy A, Mosbah A, Shady M (2008) Anastrozole or letrozole for ovulation induction in clomiphene resistant women with polycystic ovarian syndrome: a prospective randomized trial. Fertil Steril 89:1209–1212. doi:10.1016/j.fertnstert.2007.05.010
Ganesh A, Goswami SK, Chattopadhyay R, Chaudhury K, Chakravarty B (2009) Comparison of letrozole with continuous gonadotropins and clomiphene-gonadotropin combination for ovulation induction in 1387 PCOS women after clomiphene citrate failure: a randomized prospective clinical trial. J Assist Reprod Genet 26:19–24. doi:10.1007/s10815-008-9284-4
Baruah J, Roy KK, Rahman SM, Kumar S, Sharma JB, Karmakar D (2009) Endometrial effects of letrozole and clomiphene citrate in women with polycystic ovary syndrome using spiral artery Doppler. Arch Gynecol Obstet 279:311–314. doi:10.1007/s00404-008-0714-4
Biljan MM, Hemmings R, Brassard N (2005) The outcome of 150 babies following the treatment with letrozole or letrozole and gonadotropins. Fertil Steril 84(Supplement 1):95. doi:10.1016/j.fertnstert.2005.07.230
Tulandi T, Martin J, Al-Fadhli R, Kabli N, Forman R, Hitkari J, Librach C, Greenblatt E, Casper RF (2006) Congenital malformations among 911 newborns conceived after infertility treatment with letrozole or clomiphene citrate. Fertil Steril 85:1761–1765. doi:10.1016/j.fertnstert.2006.03.014
Badawy A, Shokeir A, Allam AF, Abdelhady H (2009) Pregnancy outcome after ovulation induction with aromatase inhibitors or clomiphene citrate in unexplained infertility. Acta Obstet Gynecol Scand 88:187–191. doi:10.1080/00016340802638199
Acknowledgments
The authors would like to thank Dr. M. El Rakhawy, senior lecturer and consultant of Diagnostic Radiology, Mansoura University Hospitals, for his invaluable effort doing transvaginal ultrasound assessment and follow-up of patients enabling completion of this trial report.
Conflict of interest statement
We declare that we have no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
About this article
Cite this article
Abu Hashim, H., Mashaly, A. & Badawy, A. RETRACTED ARTICLE: Letrozole versus laparoscopic ovarian diathermy for ovulation induction in clomiphene-resistant women with polycystic ovary syndrome: a randomized controlled trial. Arch Gynecol Obstet 282, 567–571 (2010). https://doi.org/10.1007/s00404-010-1566-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00404-010-1566-2