The goal of this clinical trial is to compare the effects of Metformin versus Pep2dia as adjunct treatments to Letrozole on ovulation induction and pregnancy outcomes in overweight women with polycystic ovary syndrome (PCOS). The main questions it aims to answer are:

Does Metformin improve ovulation rates more effectively than Pep2dia when used alongside Letrozole? Does Pep2dia enhance pregnancy outcomes compared to Metformin in this patient population?

Participants will:

Receive either Metformin or Pep2dia in addition to Letrozole. Undergo regular monitoring for ovulation and pregnancy outcomes. Researchers will compare the Metformin group to the Pep2dia group to see if there is a significant difference in ovulation and pregnancy rates between the two treatments.

Inclusion Criteria:

1. Anovulatory infertile women with PCOS for more than one year associated with overweight and seeking pregnancy.
2. Married women of reproductive age who lived with a husband and were sexually active.
3. Women with resistant to Letrozole.
4. Normal value of prolactin hormone.
5. Age group; 18-35 years
6. BMI ranging from 25 to 29 kg /m².
7. Standard parameters of the husband's semen
8. Diagnostic criteria for Rotterdam diagnosis of polycystic ovary syndrome:

Two of the following three criteria are required:

• Oligoovulation or Anovulation
• Hyperandrogenism: Clinical (hirsutism or less commonly male pattern alopecia) or Biochemical (raised free androgen index (FAI) or free testosterone).
• Polycystic ovaries on ultrasound (Christ et al., 2023).

Exclusion Criteria:

1. Hypersensitivity to letrozole, metformin or pep2dia.
2. Obese women with BMI ≥29 kg/m² or women with BMI <25 kg/m².
3. FSH above 11 mg.
4. Any other cause of infertility other than anovulation due to overweight as uterine factor, tubal factor, male factor, ovarian pathology or endometriosis.
5. Any medical disorder that may affect pregnancy or systemic disease (cardiovascular, renal, hepatic, CNS diseases and hypo or hyperthyroidism)
6. Missed patient
7. Discontinuation of drug due to its side effects

This study will include only female participants. The eligibility criteria specify that all participants must be women diagnosed with polycystic ovary syndrome (PCOS) who are experiencing infertility. These women should be overweight, as defined by a body mass index (BMI) within the specified range for the study. No male participants will be included in this trial.

In accordance with the decision not to share individual participant data (IPD), strict measures will ensure confidentiality. Data collection will maintain anonymity, with unique identifiers replacing personal details. All data, from demographics to outcomes, will be securely stored in encrypted databases accessible only to authorized personnel. Individual participant data won't be shared externally; aggregate data may be shared while protecting privacy. Participants will be fully informed, addressing any concerns on data privacy during consent and throughout. The study protocol will undergo ethical review, ensuring compliance with confidentiality standards. Regular audits will monitor compliance with data security, promptly addressing breaches. These measures uphold participant confidentiality while investigating Metformin and Pep2dia effects on overweight women with PCOS undergoing Letrozole-induced ovulation.