Letrozole Alone vs. Letrozole Plus Levothyroxine for Ovulation Induction in Infertile Women With Both (Polycystic Ovary Syndrome) PCOS and Sub-clinical Hypothyroidism.
Letrozole Alone vs. Letrozole Plus Levothyroxine for Ovulation Induction in Infertile Women With Both (Polycystic Ovary Syndrome) PCOS and Sub-clinical Hypothyroidism.
The goal of this randomized controlled trial is to compare letrozole alone versus letrozole plus levothyroxine for ovulation induction in infertile women with both PCOS and subclinical hypothyroidism. The main questions it aims to answer are:
Is letrozole plus levothyroxine superior to letrozole alone in achieving ovulation in these patients? Does combining levothyroxine with letrozole lead to higher pregnancy and live birth rates compared to letrozole alone?
Participants will be randomized into two groups:
Group 1 will receive letrozole only, starting at 2.5 mg daily from day 3 to 7 of the menstrual cycle. The dose will be increased up to 7.5 mg if no ovulation occurs, for a maximum treatment period of 6 months or until pregnancy is achieved.
Group 2 will receive letrozole at the same doses as group 1 plus 25 mcg levothyroxine daily.
Inclusion Criteria:
Age between 20-40 years
BMI between 18-35 kg/m2
Meet diagnostic criteria for PCOS based on the Rotterdam consensus criteria and ESHRE/ASRM modifications (2018):
Oligo- and/or anovulation Clinical and/or biochemical signs of hyperandrogenism Polycystic ovaries on ultrasound
Subclinical hypothyroidism defined as TSH level between 5-10 mIU/L with normal free T4
Infertility duration ≥ 1 year
Intact ovaries and uterus, confirmed by physical exam and imaging
Normal semen analysis in male partner
No tubal or peritoneal factor contributing to infertility
Effective contraception if not attempting conception
Willing and able to provide informed consent
Exclusion Criteria:
Known thyroid disease or on thyroid medications
Abnormal thyroid function tests other than subclinical hypothyroidism
Hyperprolactinemia
Presence of other causes of infertility such as:
Moderate to severe male factor infertility Bilateral tubal occlusion or peritoneal factors Stage III-IV endometriosis Ovarian failure or insufficiency (high FSH or low AMH)
Previous diagnosis of any type of congenital adrenal hyperplasia
Uncontrolled diabetes (HbA1C >8%)
History of deep vein thrombosis or thromboembolic events
Any contraindication to letrozole or levothyroxine
Previous use of letrozole or levothyroxine in past 6 months
Current or suspected pregnancy
Breastfeeding
Inability to comply with treatment and follow-up procedures
MuhamedAhmed.216@azhar.edu.eg01017313413