الفهرس 
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Abstract
This study is a multicenter, randomized controlled trial comparing women with PCO using Letrozole versus Letrozole plus Gonadotropin and its Effect on ongoing pregnancy rate after intrauterine insemination . It was conducted in multiple IVF centers in May 2019 and continued data collection till reaching the target number of cases. Patients’ selection and allocation were done randomly in two arms equal groups (letrozole 2.5 mg twice daily on day 2–5 of the menstrual cycle and the letrozole plus gonadotropins received gonadotropins starting from the day 7 plus letrozole 2.5 mg twice daily on day 2–5 of the menstrual cycle).
We included patients with infertility and PCO (according to Rotterdam criteria), < 35 years old, Normal thyroid-stimulating hormone and prolactin levels, normal semen analysis of their husbands, menstrual third day FSH levels < 12 IU/ml and normal hysterosalpingography; were included in the study. Patients were evaluated by transvaginal ultrasonography on the ninth day of menstruation and daily when the greatest follicle reached 14 mm. Endometrial thickness and follicular size mean were calculated. IUIN was performed. Patients were rested for 30 min on a dorsal lithotomy position after insemination.
The study included 90 patients and on testing their baseline characteristics, they showed abnormal distribution with a significant difference among the age (P= 0.002) in the two groups. In contrast, all other characteristics were comparable with no significant differences. A total of 17 patients showed a positive pregnancy test with no significant difference in both groups (P = 0.788). also, no significant difference in terms of E2 levels as well as endometrial thickness. However, there was a significant difference in the number of follicles (P< 0.001) in the two groups. All variables of post-treatment assessment showed abnormal distribution on testing them. All other characteristics were comparable with no significant differences among the two groups.
Polycystic ovary syndrome has many treatment modalities reported in the literature and one should put into account that controlled ovarian stimulation with in vitro fertilization must be considered the final option due to the highly significant risk it carries in developing ovarian hyper-stimulation syndrome (OHSS) in patients with polycystic ovary syndrome.
According to our observations, Letrozole in combination with gonadotropin results in better outcomes than Letrozole alone in terms of the number of follicles. More, high-scale double-blinded randomized clinical trials with a high sample size should be conducted to conclude the efficacy of such treatment modalities in managing polycystic ovary syndrome.