Outcome of Metformin-Letrozole Therapy In Patients With Metformin-Clomiphene Resistant Polycystic Ovarian Syndrome

Nasreen Fatima, Shawita, Anum Ellahi

  • Nasreen Fatima Department of Gynaecology and Obstetrics Ward-9 JPMC Karachi



To evaluate the therapeutic effects of combined metformin-letrozole in the treatment of sub-fertility in women with metformin clomiphene citrate resistant polycystic ovarian syndrome (PCOS).

Study design

Cross sectional study.

Place & Duration of study

Department of Obstetrics & Gynaecology, Jinnah Postgraduate Medical Centre (JPMC) Karachi, from May 2018 to November 2018.


PCOS patients attending Gynaecology outpatient department who were found resistant to the treatment with clomiphene citrate and metfomin were enrolled after taking consent. Letrozole 2.5mg tablet was advised to be used daily, orally from day 2 of menstruation cycle for five days with metformin 500mg thrice daily after two months wash out period for clomiphene citrate. Trans-vaginal ultrasound was done at 12th day of cycle for measurement of number, size of follicles and endometrial thickness. Data was collected and analyzed using SPSS version 20.


A total of 147 women with PCOS were enrolled.  Mean age of the patients was 34.74±2.81 year. Out of the total, 105 (71.4%) women showed response to the treatment. Moreover, 70 (47.6%) women achieved pregnancy. Finally, 94 (63.9%) women showed good response in terms of endometrial thickness.


The combined treatment of letrozole with metformin found helpful in restoring menstrual cycle with better rates of ovulation, improvement in the clinical sign of hyperandrogenism and higher rates of full term pregnancies.

Key words

Polycystic ovarian syndrome, Metformin, Letrozole, Infertility.