Comparison of two aromatase inhibitors in women with clomiphene-resistant polycystic ovary syndrome

Indications:22 patients with anovulation and refractory polycystic ovary syndrome.; Patients:40 female patients. Group 1/Femara group: n=22, mean age 28.4 ± 5.18 years. Group 2/anastrazole group: n=18, mean age 25.56 ± 6.26 years.; TypeofStudy:A randomized, double-blind study comparing the effect of two aromatase inhibitors (AI) (Femara and anastrozole) on ovulation induction and conception in anovulatory clomiphene-resistant women with polycystic ovary syndrome (PCOS).; DosageDuration:2.5 mg daily orally for 5 days.; ComparativeDrug:Anastrazole (Arimidex) was given at 1 mg daily orally for 5 days.; Results:On the day of hCG administration the mean endometrial thickness was 8.17 mm and 6.53 mm for Femara and anastrozole, respectively, and this difference was statistically significant (P< 0.001). The PI was 2.11 and 3.08 for Femara and anastrozole, respectively, and the difference was also statistically significant (P< 0.005). The increase in serum E2 levels was more marked in the Femara group (mean, 1640.5 pmol/l) than in the anastrozole (mean, 1447.2 pmol/l). The mean number of mature follicles on the day of hCG administration was 1.72 in the Femara group and 2.33 in the anastrozole group, and the difference was not statistically significant. The ovulation rate was higher in the Femara group (in 84.4% of cycles) than in the anastrozole group (in 60% of cycles), which was statistically significant (P< 0.05). Pregnancy occurred in 6 (27%) of the women (18.8% per cycle) in the Femara group while it was in 3 (16.6%) of women (9.7% per cycle) in the anastrozole group, and the difference between the two groups was statistically significant (P< 0.05). There was no case of multiple gestation. It was observed that the PI of the uterine arteries was less than 3 in all the women who conceived in both groups. The other observation is that in both groups, all the women who conceived had E2 levels less than 200 pmol/l at baseline and 2000 pmol/l or higher on the day of hCG administration.; AdverseEffects:No adverse events were mentioned. Multiple gestation did not occur.; AuthorsConclusions:Oral administration of AI is effective for ovulation induction and conception in anovulatory clomiphene-resistant women with PCOS, with a higher rate of success with letrozole than with anastrozole. Endometrial thickness was not adversely affected by this treatment. The limited number of mature follicles (one to two in this study) decreased the risks of multiple pregnancy and ovarian hyperstimulation syndrome.; FreeText:Serum levels of luteinizing hormone (LH), follicle-stimulating hormone (FSH), testosterone, and estradiol (E2) were assessed and ultrasound examinations were performed on day 1 or 2 of the menstrual cycle, and then from day 9 on alternating days, ending with administration of human chorionic gonadotropin (hCG). Endometrial thickness and pulsatility index (PI) of both uterine arteries were determined on the day of hCG administration. A single observer using a 5-mHz broad-band probe performed transvaginal sonography. Clomiphene resistance is recognized when a woman does not ovulate after treatment with 200 mg of clomiphene daily for 5 days per cycle, or ovulates with a very thin endometrium (≤ 5 mm) with the LH surge or when hCG would normally be administered. Human chorionic gonadotropin (10 000 U) was administered to trigger ovulation. When ovulation or pregnancy did not occur, the same treatment protocol was used with the doubling of the first dose for a maximum of two treatment cycles.