Letrozole versus Tamoxifen in Treatment of Clomiphene Citrate Resistant Polycystic Ovarian Syndrome

Objective The objective of this prospective randomized study was to make a comparison between Letrozole and Tamoxifen (TMX) effects in ovulation induction in clomiphene (CC)-resistant women with polycystic ovarian syndrome (PCOS). Material and Methods The study comprised a total of 60 infertile women (175 cycles) with CC-resistant PCOS selected from the clinics of the Department of Obstetrics and Gynecology of Tanta University Hospital. Patients were randomized to treatment with 2.5mg of letrozole daily (30 patients, 86 cycles) or 20mg of tamoxifen daily (30 patients, 89 cycles) for 5days from day 5 of menses and 10000 IU hCG when mature follicles becomes ?18 mm in diameter. Results The total number of follicles was more in the letrozole group (?18mm). The endometrial thickness at the time of hCG administration was significantly high (p<0.05, at 95% CI) in the letrozole group than that of tamoxifen group (10.2 ± 0.7 vs. 9.1 ± 0.2mm). Ovulation occurred in 23.33% in the letrozole group and in 8.89% in the tamoxifen group, whereas pregnancy occurred in 5.56% in the letrozole group and in 2.22% in the tamoxifen group. Conclusion Both letrozole and TMX should be considered asoptional therapy for CC-resistant women. In addition, letrozole was super to TMX in achieving a higher pregnancy and ovulation induction rate, and lesser side effects than tamoxifen.