Randomized controlled trial comparing letrozole with laparoscopic ovarian drilling in women with clomiphene citrate-resistant polycystic ovary syndrome

The aim of the present study was to compare the reproductive outcomes of letrozole and laparoscopic ovarian drilling (LOD) in women with clomiphene citrate (CC)-resistant polycystic ovary syndrome (PCOS). A total of 141 women with CC-resistant PCOS were enrolled and randomly allocated into groups A and B. Group A (n=71) received 2.5 mg letrozole from days 5 to 10 of menses for up to six cycles, and group B (n=70) underwent LOD. A 6-month follow-up was performed. No statistically significant difference was found in the baseline clinical characteristics and the major serum hormone profiles, including luteinizing hormone, follicle-stimulating hormone, estradiol and free testosterone, between the two groups. Women receiving letrozole had a lower rate of spontaneous abortion (6.9 vs. 15.8%) and higher clinical pregnancy (40.8 vs. 27.1%) and live birth (38.0 vs. 22.9%) rates; however, the differences were not statistically significant. Letrozole had superior reproductive outcomes compared with LOD in women with CC-resistant PCOS; therefore, letrozole could be used as the first-line treatment for women with CC-resistant PCOS.