Efficacy and Safety of Letrozole Add-on Injection HMG on Ovulation and Pregnancy: Comparison with Letrozole Alone

Background: Nowadays, Infertility is increasing worldwide. Many regimens are used in the treatment of infertility. Among them, a combination of oral aromatase inhibitor drugs and gonadotropin is recommended as a very effective regimen for inducing ovulation. But there is a scarcity of related data in the Bangladesh context. The present study was designed to compare the effect of letrozole and the combination of letrozole with low-dose intramuscular injection of HMG on ovulation and pregnancy. Methods: This randomized controlled trial was conducted at the department of Obstetrics and Gynaecology in Rajshahi Medical College Hospital from June 2020 to May 2021. A total of 95 patients with a history of infertility were selected as the study population according to inclusion and exclusion criteria. Written informed consent was obtained from each patient. All of them were randomly distributed into two groups, group-A, and group B, by the flipping coin method, where group-A (Experimental group) patients received letrozole with low dose intramuscular injection of HMG (45 patients) and group B (Control group) patients received Letrozole only (50 patients). Relevant investigations were done, along with scheduled follow-ups. Results: Mean age of the study patients was 26.86±3.71 (SD) years, whereas the majority were ≤30 years (74.7%). Age was statistically similar among the patients of both groups. The endometrial thickness, follicular diameter, and a number of mature follicles were statistically higher among patients who received letrozole with low dose intramuscular injection of HMG than the patients who received only letrozole. Maximum follicular diameter ≥18mm (91.1%) in group-A among them (60%) achieved in 1st Cycle. Maximum endometrial thickness was achieved in the first Cycle in both groups (60% vs. 32%) among group-A patients. The positive pregnancy rate was also higher among group-A patients (37.8% vs. 22.0%) in 1st Cycle. Ovarian Hyperstimulation Syndrome was observe