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Comparative study between clomiphene and Letrozole for ovulation induction in patients with polycyst

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Comparative study between clomiphene and
Letrozole for ovulation induction in patients with polycystic
ovarian syndrome
[Writers name]
SUPERVISOR
[Supervisors name]
ZIAUDDIN UNIVERSITY
Synopsis

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INTRODUCTION
Polycystic ovary syndrome is a heterogeneous endocrine dysfunction that affects about ¼
of women worldwide. This is majorly due to excessive androgen secretion or activity in the body
and an enormous number of women may also have abnormal insulin activity. Various systems of
the body get disturbed due to polycystic ovarian syndrome resulting in several complications
including menstrual dysfunction, infertility, hirsutism, acne, obesity, and metabolic syndrome.
Women with this disorder have an established increased risk of developing type 2 diabetes i.e.;
non-insulin dependent and a still debated increased risk of cardiovascular disorder.
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.
Generally there was no significant difference seen in responders and non-responders of
letrozole in age, period of infertility, body mass index, and LH, FSH, or LH/FSH ratio.
This syndrome is common in women of reproductive age. Infrequent or prolonged
menstrual periods, excess hair growth, acne and obesity can all occur at once or individually in
women with polycystic ovary syndrome. Infrequent or absent menstruation may indicate the
presence of this condition. In women, weight gain and difficulty in conceiving is the first sign of
this syndrome.
Clomiphene is a standard drug for the ovulation induction and is still considered as the
first line therapy treatment for the PCOS. However clomiphene has certain disadvantages as
well. It is associated with inconsistency in ovulation (60-85%) and pregnancy rate (10-20%).

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Miscarriage rate is much higher in these patients than general women, and 20-25% PCOS
women are unaffected to clomiphene.
Letrozole is an orally active ovarian cancer inhibitor which is potentially useful for
ovulation induction. It is now in use for the past few years. Letrozole mainly acts by reducing
estrogen production by blocking androgens to estrogens conversion. Additionally, no adverse
effect on endometrial layer and cervical mucus is seen. Letrozole has been shown to have good
ovulation outcome in clomiphene citrate resistant women who are suffering from polycystic
ovarian syndrome. PCOS women who are likely to be clomiphene resistant may also be resistant
to insulin. Letrozole could prove to be a good alternative for ovulation induction in such women.
Clomiphene citrate (CC) has been used for ovulation induction since 1960s. It is still
considered first-line drug for an ovulatory PCOS women. However, clomiphene resistance (15-
20%), endometrial thinning, and poor cervical mucus (15-50% of cases) makes it ineffective in
many situations. Letrozole, which is an aromatase inhibitor, has been explored as a good
alternative these days. Letrozole creates an estrogen-deficient environment by blocking
conversion of androgens to estrogens. Letrozole has also been shown to be effective in ovulation
induction in CC-resistant PCOS women. This could be one more reason for letrozole to be a
better first-line drug compared to clomiphene citrate.
Both clomiphene citrate and letrozole are medications used to treat infertile women who
have an ovulation problem. These medications work by helping your pituitary gland (located at
the base of the brain) improve the stimulation of developing follicles (eggs) in the ovaries.

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INTRODUCTIONPolycystic ovary syndrome is a heterogeneous endocrine dysfunction that affects about of women worldwide. This is majorly due to excessive androgen secretion or activity in the body and an enormous number of women may also have abnormal insulin activity. Various systems of the body get disturbed due to polycystic ovarian syndrome resulting in several complications including menstrual dysfunction, infertility, hirsutism, acne, obesity, and metabolic syndrome. Women with this disorder have an established increased risk of developing type 2 diabetes i.e.; non-insulin dependent and a still debated increased risk of cardiovascular disorder.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.Generally there was no significant difference seen in responders and non-responders of letrozole in age, period of infertility, body mass index, and LH, FSH, or LH/FSH ratio.This syndrome is common in women of reproductive age. Infrequent or prolonged menstrual periods, excess hair growth, acne and obesity can all occur at once or individually in women with polycystic ovary syndrome. Infrequent or absent menstruation may indicate the presence of this condition. In women, weight gain and difficulty in conceiving is the first sign of this syndrome.Clomiphene is a standard drug f ...
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