Evaluation of the Effectiveness of Letrozole-Based Ovulation Induction in a Center of the Rural Women with Polycystic Ovary Syndrome

Abstract

Background: Polycystic ovary syndrome (PCOS) is a leading cause of anovulatory infertility, with letrozole emerging as an effective first-line ovulation induction agent. Evidence from rural populations remains limited, despite potential differences in clinical presentation, treatment responsiveness, and access to reproductive care. This study aimed to evaluate the effectiveness of letrozole-based ovulation induction in rural women with PCOS who achieved positive pregnancy outcomes. Methods: This prospective observational study included 60 women treated at Jahurunessa Hospital, Rupganj, Narayanganj, from June 2024 to July 2025. Baseline demographic, hormonal, and clinical features were recorded. Treatment characteristics, ovulatory response, and pregnancy outcomes were evaluated. Data were analyzed using SPSS version 25.0. Results: The mean age of the study population was 23.38 ± 3.1 years and a BMI of 26.42 ± 1.98 kg/m². Oligomenorrhea (90%) and hyperandrogenism (83.3%) were prevalent. All women achieved ovulation, with a median of 1 (IQR 1–2) mature follicles and a mean endometrial thickness of 10.5 ± 1.4 mm. Clinical pregnancy was confirmed in all cases, while biochemical pregnancy occurred in 70%. Live birth, ongoing pregnancy, abortion, and ectopic pregnancy rates were 76.7%, 15%, 6.7%, and 1.7%, respectively. Complications were minimal, including ovarian hyperstimulation syndrome (6.7%) and multiple pregnancy (5%). Conclusion: Letrozolebased ovulation induction demonstrated excellent ovulatory and reproductive outcomes in rural women with PCOS, supporting its use as an effective and feasible first-line therapy in resource-limited settings.

Sir Salimullah Med Coll J 2025; 33: 19-25