Abstract Background: Polycystic ovary syndrome (PCOS) is a leading cause of anovulatory infertility, and optimizing ovulation induction strategies remains a key challenge in improving reproductive outcomes. Methods: A randomized controlled trial was conducted in the Department of Obstetrics and Gynaecology, SMS Medical College, Jaipur, from October 2023 to October 2024. A total of 148 infertile women with PCOS (Rotterdam criteria) unresponsive to 2.5 mg letrozole were randomized into two groups: Group 1 received the conventional letrozole regimen (5 mg/day for 5 days), and Group 2 received the extended regimen (5 mg/day for 10 days). Ovulation was monitored by transvaginal ultrasonography, and outcomes were compared based on prior OCP use. Data were analysed using SPSS v26 with a significance threshold of p< 0.05. Results: The extended regimen achieved a higher ovulation rate (91.89%) compared with the conventional regimen (70.27%) (p = 0.0005). Among women with prior OCP use, ovulation occurred in 100% of cases (28/28 in the conventional group and 38/38 in the extended group). In contrast, among non-OCP users, ovulation occurred in 65.9% of participants. Statistical analysis revealed a strong association between prior OCP exposure and ovulatory success (χ² = 25.61, p< 0.001), with an odds ratio (OR) of 69.55 (95% CI: 3.95–1224.2). Conclusion: OCP pretreatment significantly enhances ovulation success in infertile PCOS women undergoing letrozole-induced ovulation, particularly with extended dosing. The combination of short-term OCP exposure followed by extended letrozole therapy appears to improve follicular responsiveness and may represent a more effective, evidence-based strategy for managing letrozole-resistant PCOS cases.
International Journal of Medical Science and Advanced Clinical Research (IJMACR) (Sun,) studied this question.