The effect of using letrozole alone protocol versus using letrozole and HCG protocol on induction of ovulation in polycystic ovarian syndrome patients: A prospective cohort study

Published: 28 May 2024| Version 1 | DOI: 10.17632/hk6pcjn37y.1
Rania Gamal EL-skaan


Abstract: Background: This study aims to challenge the routine use of HCG in simple letrozole induction protocols, suggesting its limited necessity in specific cases, potentially reducing costs and stress for infertile couples. Material and Methods: This is a prospective cohort study was done at the assisted reproductive unit in Ahmed Maher teaching hospital in Cairo. The study includes 132 infertile women aged 18 to 35 with PCOS, free from other medical disorders and not taking conflicting medications. Prerequisites involve normal hysterosalpingography and semen analysis. Participants were evenly divided into two groups: the first receiving letrozole exclusively for ovulation induction, and the second receiving letrozole with HCG when suspected ovulation maturity occurred. Following a 2-week period, both groups underwent a pregnancy test, and individuals with positive results received a transvaginal ultrasound one week later for clinical pregnancy confirmation. Results: Positive pregnancy tests were identical in both groups (15 women, 22.7%, P-value = 1). Regarding clinical pregnancy, the Letrozole-only group exhibited 14 pregnancies (21.2%), slightly higher than the Letrozole+HCG group with 13 pregnancies (19.7%), though the difference was statistically non-significant (p-value = 0.829). Conclusion: The study suggests a slightly higher effectiveness of the letrozole-only protocol for fertility treatment in women with polycystic ovary syndrome, specifically regarding clinical pregnancy, compared to the letrozole+HCG protocol. The findings further recommend limiting HCG use to cases necessitating intrauterine insemination or for individuals diagnosed with luteinized unruptured follicle syndrome. Keywords: Letrozole, PCO, Induction of ovulation, Infertility



Ain Shams University Faculty of Medicine


Medical Quantitative Analysis