Allocation, treatment protocol and follow-up
dizziness, blurred vision, headache, nausea, vomiting
WITHDRAWAL BLEEDING
Women were randomly allocated into two groups, with each group consisting of 50 participants. The first group underwent the stair-step pattern of ovulation induction using clomid at a dose of 50 mg (single daily dose) from day two of the cycle until day 6 (spontaneous or induced menses). The same stair-step pattern was followed in the second group, but they received letrozole at a dose of 2.5 mg (once daily) from day 2 of the cycle for 5 days. Ultrasound examination was conducted 6 to 7 days after the last dose of the drug and if follicle size was ≥ 18 mm, 10,000 IU hCG was administered for ovulation induction.In cases where no follicle reaction was observed (all follicles <10 mm) or the single follicle size was <18 mm, the daily drug dose of either clomid or letrozole was immediately doubled without withdrawal bleeding and given for another 5 days. Subsequent ultrasound examinations were conducted 7 days after the last dose. If the desired follicle size of >18 mm was not achieved, the process was repeated by tripling the initial dose of clomid or letrozole, with maximum doses of 150 mg and 7.5 mg, respectively, and hCG was administered accordingly.Ovulation was considered successful when confirmed by a positive ovulation test kit or documented ultrasound evidence of a follicle of at least 18 mm size that was likely to ovulate. The treatment protocol was repeated for three cycles on the same menstrual cycle, depending on the follicle size. The study started in March 2021 and ended in July 2022. Data on age, body mass index (BMI), parity, thyroid stimulating hormone level, fasting blood sugar and prolactin level were collected. Women were followed up to assess overall ovulation rate, pregnancy rate and mean time from menstruation to ovulation. Safety was assessed based on the frequency of nausea, vomiting, headache, dizziness and blurred vision.