Polycystic ovary syndrome is a common endocrine disorder in young women and manifests as infertility in 55-75%. Clomiphene citrate is still the standard drug for inducing or augmenting ovulation. It is not, however, equally successful in all situations. L Metromile is an aromatase inhibitor and is one of the alternative treatments to Clomiphene. This study aims to answer the question (does letrozole add anything to the art Of ovulation induction and represent a real alternative to Clomiphene? To compare the effects of letrozole (5 mg) and clomiphene citrate (100 mg) for ovulation induction in women with polycystic ovary syndrome. A prospective randomized trial study was done at Tikrit Teaching Hospital. The study comprised a total of 40 infertile women with polycystic ovary syndrome; Patients were randomized to treatment with 5 mg Of letrozole daily (20 patients) or 100 mg of clomiphene citrate daily (20 patients) for 5 days starting on day 3 Of menses. Timed intercourse was advised 24-36 hours after hCG injection. Then, both groups were followed by sonography every other day from day 10 Of the menstrual cycle for the number and size Of follicles and endometrial thickness were assessed. The study revealed that the C . C group induce ovum with size > 18mm 12 (60%) versus 17 (85%) among Letrzol group, while < 18mm in about 8 C.C group as compared with 3 (15%) in Letrzol group, this relation was statistically not significant. The study revealed that C.C group induce > 1 follicle 8 (40%) versus 2 (10%) among Letrzol group, while I follicle induced in about 6 (30%) in C.C group as compared with 16 (80%) in Letrzol group, this relation was statistically significant. The endometrium thickness was 4-5 mm in 14 (70%) among C.C group, and 17 (85%) in Letrzol group , while uterine thickness was 6-9.5mm in 6 (30%) among C.C group and 3 (15%) among Letrzol group, this relation was statistically not significant, study conclude that Letrozole should be considered as first line drug to get away from clomiphene's unwanted effects like thin endometrium and multifolliculogesis.


letrozole endometrium clomiphene citrate ovulation


How to Cite
Dr. Sama Mohammed Ali, Dr. INAS FADHIL ABDULHUSSEIN, & Dr. Suhair Neima Kazom. (2024). Comparison of Letrozole vs Clomiphene Citrate for induction of ovulation in polycystic ovarian syndromeAn Iraqi study. Texas Journal of Medical Science, 30, 23–39. https://doi.org/10.62480/tjms.2024.vol30.pp23-39


  1. Adam H Balen. 2007. Polycystic Ovary Syndrome and Secondary Amenorrhoea. In: D. Keith Edmonds. Ed. Dewhurst's Textbook of Obstetrics & Gynaecology, 70' Edition. Blackwell Publishing, pp.377-99.
  2. Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks to polycystic ovary syndrome. Fertil Steril. 2004
  3. Sharma A, YousefM, Burrill R, Atiomo W. Recent developments in polycystic ovary syndrome Studies.J. in Obstetrics and Gynaecology.
  4. Di Marcantonio T. (2008) Controva•sy around the Definition of PCOS continues. Endrocrine today, April. [Online] comgndQGLinology/endocriniologyfreprodugtion-
  5. March W, Moore V, Willson K et al. (2010): The prevalence of polycystic ovary syndrome in a community sample assessed under contrasting diagnostic criteria. Hum Reprod., 25 (2): 544-51.
  6. Sirmans S, Pate K (2013): Epidemiology, diagnosis, and management of polycystic ovary syndrome. Clin Epidemiol., 6: 1-13
  7. Bart C (2004): Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril., 97 (1): 28-38.
  8. McFarland C (2012): Treating polycystic ovary syndrome and infertility. Am J Matern Child Nurs., 37 (2): 116-21.
  9. ACOG practice bulletin (2009): Polycystic ovary syndrome. Obstet. Gynecol., 114 (4): 936-49.
  10. Hasanpoor-Azghdy S, Simbar M, Vedadhir A (2014): The emotional-psychological consequences of infertility among infertile women seeking treatment: Results of a qualitative study. Iran J Reprod Med., 12 (2): 131-8.
  11. Fauser B, Tarlatzis B, Rebar R et al. (2012): Consensus on women’s health aspects of polycystic ovary syndrome (PCOS): the Amsterdam ESHRE/ASRM-Sponsored 3rd PCOS Consensus Workshop Group. Fertil Steril., 97(1):28-38.
  12. Imani B, Eijkemans M, Velde E et al. (1998): Predictors of Patients Remaining Anovulatory during Clomiphene Citrate Induction of Ovulation in Normogonadotropic Oligoamenorrheic Infertility. J Clin Endocrinol Metab., 83 (7): 2361-5.
  13. Tarlatzis B, Fauser B, Legro R et al. (2008): Consensus on infertility treatment related to polycystic ovary syndrome: The Thessaloniki ESHRE-ASRM-Sponsored PCOS Consensus Working Group. Fertil Steril., 89 (3): 505-22.
  14. He D, Ma X ( Clinical utility of Letrozole in the treatment of breast cancer: A Chinese perspective. Onco Targets Ther., 9: 1077–1084.
  15. Joham AE, Teede HJ, Ranasinha S, Zoungas S, Boyle J. Prevalence of infertility and use of fertility treatment in women with polycystic ovary syndrome: Data from a large community-based cohort study. J Womens Health (Larchmt). 2015;24(4):299-307.doi: 10.1089/ jwh.2014.5000
  16. Li M, Ruan X, Mueck AO. Management strategy of infertility in polycystic ovary syndrome. Glob Heal J. 2022;6(2):70-74. doi: 10.1016/J.GLOHJ. .03.002
  17. Collee J, Mawet M, Tebache L, Nisolle M, Brichant G. Polycystic ovarian syndrome and infertility: Overview and insights of the putative treatments. Gynecological Endocrinol. ;37(10):869-874. doi: 10.1080/09513590.2021.1958310
  18. Seyedoshohadaei F, Tangestani L, Zandvakili F, Rashadmanesh N. Comparison of the Effect of Clomiphene- Estradiol Valerate vs Letrozole on Endometrial Thickness, Abortion and Pregnancy Rate in Infertile Women with Polycystic Ovarian Syndrome. J Clin Diag Res. 201 ;10(8):QC10. doi: 10.7860/JCDR/2016/20954.8324
  19. Amer SA, Smith J, Mahran A, Fox P, Fakis A. Double-blind randomized controlled trial of letrozole versus clomiphene citrate in subfertile women with polycystic ovarian syndrome. Hum Reprod. 32(8):1631-1638. doi: 10.1093/humrep/dex227
  20. Franik S, Eltrop SM, Kremer JA M, Kiesel L, Farquhar C. Aromatase inhibitors (letrozole) for subfertile women with polycystic ovary syndrome. Cochrane Database Syst Rev. 5(5):CD010287. doi: 10.1002/14651858.CD010287.PUB3
  21. Melo AS, Ferriani RA, Navarro PA. Treatment of infertility in women with polycystic ovary syndrome: approach to clinical practice. Clinics (Sao Paulo). ;70(11):765-9. doi: 10.6061/ clinics (11)09
  22. Costello MF, Misso ML, Balen A, Boyle J, Devoto L, Garad RM, et al. Evidence summaries and recommendations from the international evidence-based guideline for the assessment and
  23. management of polycystic ovary syndrome: assessment and treatment of infertility. Hum Reprod Open. (1):hoy021. doi: 10.1093/hropen/hoy021
  24. Sidra S, Tariq MH, Farrukh MJ, Mohsin M. Evaluation of clinical manifestations, health risks, and quality of life among women with polycystic ovary syndrome. PLoS One. 14(10):0223329. doi:
  25. 1371/journal.pone.0223329
  26. Khakwani M, Parveen R, Yousaf S, Tareen AU. Efficacy of letrozole versus clomiphene citrate on ovulation induction in patients with polycystic ovarian syndrome. Pak J Med Sci. 2022;38(5):1155-1158. doi: 10.12669/pjms.38.5.5565
  27. Li YY, Ye SQ, Zhong ZH, Xu Q, Mai WB, Yin CX, et al. Associations between maternal BMI as well as glucose tolerance and adverse pregnancy outcomes in women with polycystic ovary syndrome. Gynecol Endocrinol. ;33(4):328-331. doi: 10.1080/09513590.2016.1261104
  28. Legro RS, Brzyski RG, Diamond MP, Coutifaris C, Schlaff WD, Casson P et al. Letrozole versus clomiphene for infertility in the polycystic ovary syndrome. N Engl J Med. ;371:119-129. doi: 10.1056/NEJMoa1313517