Endometrial Response in Polyendocrine Metabolic Ovarian Syndrome (PMOS) Treated With Letrozole Alone or With Added Estradiol Valerate

Polyendocrine Metabolic Ovarian Syndrome (PMOS) is one of the most common endocrine disorders among women of reproductive age, characterized by chronic anovulation, hyperandrogenism, and polycystic ovarian morphology. Letrozole, an aromatase inhibitor, has emerged as a first-line ovulation induction agent due to its superior ovulation and pregnancy rates compared to clomiphene citrate. Estradiol valerate, a synthetic estrogen, can be co-administered with letrozole to improve endometrial receptivity by enhancing endometrial thickness, vascularity, and pattern. This study aims to evaluate the effect of letrozole alone versus letrozole with estradiol valerate on endometrial development in these patients.

Inclusion Criteria: * Women aged 20-35 years * Clinical diagnosis of PMOS (Rotterdam criteria) Exclusion Criteria: * Endocrine disorders other than PMOS * Endometrial pathology or uterine malformations * Allergy to letrozole or estradiol * Hormonal therapy within last 3 months