Comparative Effectiveness of Letrozole Alone versus Letrozole Plus Oradexon in Ovulation Induction Among Rural Women with PCOS: A Retrospective Analysis of 60 Positive Pregnancies

Open Access

Abstract

Background: Polycystic ovary syndrome (PCOS) is a prevalent endocrine disorder and the leading cause of anovulatory infertility among reproductive-aged women. Letrozole is currently recommended as first-line ovulation induction therapy; however, adjunctive glucocorticoids have been proposed to enhance ovarian response, particularly in hyperandrogenic populations. This study aimed to compare the effectiveness of letrozole alone versus letrozole combined with oradexon for ovulation induction among rural women with PCOS. Methods & Materials: This retrospective comparative study was conducted at Jahurunessa Hospital, Rupganj, Narayanganj, from June 2024 to May 2025. Sixty women diagnosed with PCOS based on Rotterdam criteria were included in this study. Participants underwent ovulation induction with either letrozole alone (n = 36) or letrozole plus oradexon (n = 24). Baseline demographic, hormonal and ultrasonographic parameters, follicular response, endometrial thickness, ovulation and pregnancy outcomes were analyzed using SPSS version 25.0. Results: Baseline characteristics, hormonal profiles, PCOS phenotypes and ovarian reserve markers were comparable between groups. The combination therapy group demonstrated a significantly higher mean number of mature follicles (≥18 mm) at trigger compared with the letrozole-alone group (1.92 ± 0.65 vs. 1.19 ± 0.47; p < 0.001). Endometrial thickness at trigger was higher in combination therapy (10.08±1.57 vs 10.92±1.25; p=0.032). However, ovulation rates, pregnancy rates and clinical pregnancy rates did not differ significantly between groups. Conclusion: Although the addition of oradexon to letrozole significantly enhanced follicular response, it did not translate into improved ovulation or pregnancy outcomes. Letrozole monotherapy remains an effective, safe and practical first-line ovulation induction strategy for rural women with PCOS.