Efficacy of combined metformin-letrozole in comparison with bilateral ovarian drilling in clomiphene-resistant infertile women with polycystic ovarian syndrome.
OBJECTIVE
To compare the hormonal-metabolic profiles and reproductive outcomes between women receiving metformin plus letrozole and women undergoing bilateral ovarian drilling in clomiphene citrate (CC)-resistant women with polycystic ovary syndrome (PCOS).


METHODS
In this randomized study, 146 patients were randomly allocated into group 1 (n = 73) who received metformin plus letrozole, and group 2 (n = 73) who underwent bilateral ovarian drilling. Comparison was done between the basal and after treatment biochemical values for each group, in addition reproductive outcomes after treatment were compared between both groups.


RESULTS
There was significant reduction in testosterone (p ≤ 0.001), fasting insulin (p ≤ 0.001), and fasting glucose/fasting insulin ratio (p = 0.029) in metformin plus letrozole group, while there was significant reduction in FSH, LH and LH/FSH ratio in bilateral drilling group (p ≤ 0.001, 0.001 and 0.001). No significant difference in cycle regularity (p = 0.82), ovulation (p = 0.24), pregnancy rate (p = 0.32) and abortion rate (p = 0.51) between both groups.


CONCLUSIONS
Both metformin plus letrozole and bilateral ovarian drilling are similarly effective as second-line strategies for the treatment of women with PCOS who do not conceive with CC.
Department of Obstetric and Gynecology, Faculty of Medicine, Zagazig University, Zagazig, Egypt. IbrahimSharkwy@yahoo.com
Ibrahim
I
Abd Elgafor
D000328:Adult; D047072:Aromatase Inhibitors / Q000627:therapeutic use*; D001786:Blood Glucose; D002996:Clomiphene / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D005300:Fertility Agents, Female / Q000627:therapeutic use*; D005640:Follicle Stimulating Hormone / Q000097:blood; D006801:Humans; D007247:Infertility, Female / Q000097:blood / Q000209:etiology / Q000628:therapy*; D007328:Insulin / Q000097:blood; D000077289:Letrozole; D007986:Luteinizing Hormone / Q000097:blood; D008687:Metformin / Q000627:therapeutic use*; D009570:Nitriles / Q000627:therapeutic use*; D010053:Ovary / Q000601:surgery*; D010062:Ovulation Induction / Q000379:methods*; D011085:Polycystic Ovary Syndrome / Q000097:blood / Q000150:complications; D011247:Pregnancy; D018873:Pregnancy Rate; D013739:Testosterone / Q000097:blood; D014230:Triazoles / Q000627:therapeutic use*; D055815:Young Adult
D047072:Aromatase Inhibitors; D001786:Blood Glucose; D005300:Fertility Agents, Female; D007328:Insulin; D009570:Nitriles; D014230:Triazoles; D002996:Clomiphene; D013739:Testosterone; D000077289:Letrozole; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone; D008687:Metformin