The objective of this study was to compare the efficacy of letrozole versus clomiphene citrate as an ovulation induction drug in polycystic ovarian syndrome (PCOS) patients of Indian origin. One hundred and forty seven infertile PCOS patients were randomly given letrozole (2.5 mg) (n = 69) or clomiphene (100 mg) (n = 78) from day 3 to day 7 of menstrual cycle, followed-up with transvaginal serial folliculometry from day 9. 10,000 IU of human chorionic gonadotropin (hCG) was administered when at least 1 ovarian follicle was a parts per thousand yen 18 mm in size. The pertinent results of the study are as follows: on the day of hCG injection, mean E2 level was significantly higher in the clomphene citrate group (817 +/- A 286.70 pg/ml) in comparison with letrozole group (444.03 +/- A 85.42 pg/ml). Mean endometrial development was 8.72 +/- A 1.41 mm in the letrozole and 8.78 +/- A 1.16 mm in the clomiphene group (P = 0.004). Letrozole has beneficial effect on endometrium, thereby potentially increasing pregnancy rates after successful ovulation induction in women with PCOS.