INTRODUCTION
obesity, breast cancer, PCOS, infertility, amenorrhea, acne
OBESITY, BREAST CANCER, WITHDRAWAL BLEED, ACNE, POLYCYSTIC OVARY SYNDROME, EXCESSIVE HAIR GROWTH, OVARIAN CYSTS
Polycystic ovary syndrome (PCOS) is characterized by menstrual irregularities, high androgen levels, and ovarian cysts. Clomiphene citrate (Clomid) and letrozole have both been investigated as ovulation induction therapies for PCOS. This interventional study aimed to compare the efficacy and safety of a stairstep practice of letrozole versus clomiphene citrate in women with PCOS. A total of 100 women diagnosed with PCOS and infertility participated in the study, which took place from March 2021 to July 2022 at the Maternity and Children Teaching Hospital in Adiwaniyah Province, Iraq. Participants were randomly assigned to one of two groups (each with 50 women): the first group received clomiphene citrate in a stair step pattern (single dose of 50 mg, 100 mg, and 150 mg) for five days, for a maximum of three cycles; the second group received letrozole in a stair step pattern (single dose of 2.5, 5, and 7.5 mg) for five days, for a maximum of three cycles. Follicle size was monitored using ultrasound to achieve a follicle size >18 mm. The ovulation rate was higher in the letrozole group (86.0%) compared to the clomiphene citrate group (72.0%), although the difference was not statistically significant (p=0.086). The pregnancy rate was slightly higher in the letrozole group (22.0% Polycystic ovary syndrome (PCOS) is a complex clinical condition characterized by menstrual irregularities, high levels of androgen, and cystic changes in the ovaries [PCOS is frequently diagnosed in women presenting with infertility, excessive hair growth, amenorrhea, acne, and obesity [One of the primary pharmacological agents utilized to induce ovulation in the treatment of PCOS, is clomiphene citrate (Clomid) [Letrozole, primarily known for its use in certain breast cancer cases, has also been explored as an effective ovulation inducer [The “stair step” protocol eliminates the use of progestin to induce a withdrawal bleed between successive treatment cycles. By eliminating the progestin withdrawal step, the time to ovulation is reduced, allowing for a more rapid administration of the ovulation-inducing medication. Stair-step procedures using clomiphene citrate (CC) have been extensively studied for ovulation stimulation [