الفهرس 
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Abstract
Polycystic ovary syndrome is one of the most common causes of infertility affecting 6% women within reproductive age & still increasing due to lifestyle changes and other familial factors. Ovulation induction is the mainstay of treatment for infertile couple after primary evaluation and failure of medical method seeks surgical intervention.
Clomiphene citrate (CC) is still holding its place for ovulation induction being simple, safe, cheap and effective. However, clomiphene-resistance, i.e., failure to ovulate after receiving 150 mg/day for at least three cycles for five days per cycle affects 15% - 40% of patients with PCOS. Aromatase inhibitors (letrozole), which block estrogen synthesis, directly affect hypothalamic– pituitary–ovarian function and theoretically might increase pregnancy rates. Letrozole has become the first line drug for induction of ovulation in PCOS patients.
The current study was performed to evaluate cost effectiveness of LE versus CC in induction of ovulation in patients with PCOS. The enrolled 212 women with PCOS and were randomly subdivided into two groups; CC group who was treated with 100 mg/day (n= 106 patients) and LE group who was treated with 5 mg/day (n= 106 patients). Ovulation, pregnancy and cost were recorded.
Baseline data and obstetric and menstrual history showed no significant diffrences between both groups. Body mass index was elevated nearly in all patients. It was found that number and size of follicles were significantly higher in LE group while endometrial thickness was insignificantly higher in LE.
The current study showed that both groups had insignificant difference as ovulation rate (83 (78.3%) vs. 90 (84.9%); p= 0.14)) while pregnancy rate was significantly higher among LE group (34 (32.1%) vs. 21 (20.2%); p= 0.03) in comparison to CC group.
Total among CC and LE group was 6446 vs. 52052 Egyptian pounds. As mentioned above 21 (20.2%) women in CC group had got pregnant while 34 (32.1%) women in LE group had got pregnant. So, net cost of using LE = 52052- 6446= 45606. Also, LE group had additional 13 women had got pregnant with the use of LE. Finally, for each additional case got pregnant with LE, the cost will be= 45606/13= 3508.16 Egyptian pounds.
In conclusion, although LE and CC had insignificantly diffrences as regard ovulation rate but patients who were treated with LE had higher pregnancy rate. Although the cost of treatment with LE is a challengeable issue, but for each additional case got pregnant with LE usage the additional cost was 3508.16 Egyptian pounds.
It’s recommend to perform such study in large scale of patients in multiple centers. Also, long-term follow up is recommended to evaluate the outcome of pregnancy. Future studies about safety of those agents on fetus and frequency of miscarriage and congenital anomalies are warranted.