Ovulation rates in a stair-step protocol with Letrozole vs clomiphene citrate in patients with polycystic ovarian syndrome

Abstract

PurposeTo compare ovulation rates between Letrozole and Clomiphene Citrate (CC) using a stair-step protocol to achieve ovulation induction in women with Polycystic Ovarian Syndrome (PCOS).MethodsThis is a retrospective cohort of predominantly Hispanic PCOS women of reproductive age who completed ovulation induction (OI) comparing women who underwent Letrozole stair-step protocol to those who underwent OI with CC stair-step. All women had a diagnosis of PCOS based on the 2003 Rotterdam criteria. For both protocols, sequentially higher doses of Letrozole or CC were given 7 days after the last dose if no dominant follicles were seen on ultrasonography. The primary outcome was ovulation rate (determined by presence of a dominant follicle) between the two treatment groups. Secondary outcomes included time to ovulation, clinical pregnancy rates and side effects.Results49 PCOS patients completed a Letrozole stair-step cycle and 43 completed a CC stair-step cycle for OI. Overall, demographics were comparable between both groups. Ovulation rates with the Letrozole stair-step protocol were equivalent to CC stair-step protocol (96% vs 88%, p = 0.17). Although the mean time (days) to ovulation was shorter in the Letrozole group (19.5 vs 23.1, p = 0.027), the pregnancy rates were similar for both groups.ConclusionsThis is the first study to date that has compared the efficacy of the stair-step protocol in PCOS patients using Letrozole and CC. Both Letrozole and CC can be prescribed in a stair-step fashion. Letrozole stair-step was as efficacious as CC stair-step; patients achieved comparable rates of ovulation and clinical pregnancy. Time to ovulation was shorter in the Letrozole protocol.

Comparison of the efficacy of letrozole stair‐step protocol with clomiphene citrate stair‐step protocol in the management of clomiphene citrate‐resistant polycystic ovary syndrome patients

“…Budinetz et al stated an increased risk of multiple pregnancies with the CC stair‐step protocol than the traditional regimen 23 . However, Thomas et al detected no multiple pregnancies in both LTZ and CC stair‐step groups 21 . In this study, no multiple pregnancies were observed in the LTZ stair‐step group, while two multiple pregnancies occurred in the CC stair‐step group ( p = 0.803).…”

“…We calculated the sample size by using the G-Power version 3.1.9.4 (Universität Kiel, Germany), regarding the values indicated in the previous studies. 21 The minimum number of patients to be included in the study was 94, with a two-tailed alpha error of 0.05 and a power of 95%. Since 117 patients were included in our study, the power of the study was calculated as >95%.…”

D-chiro-inositol Induces Ovulation in Non-Polycystic Ovary Syndrome (PCOS), Non-Insulin-Resistant Young Women, Likely by Modulating Aromatase Expression: A Report of 2 Cases

“…In addition to enhancing the hypothalamic response, it increases the FSH sensitivity of the ovaries [ 44 ]. Due to its shorter half life, compared to CC, letrozole does not interfere with endometrial proliferation and reduces the occurrence of multiple pregnancies in ART protocols [ 45 , 46 ]. However, such use of letrozole is off label in many countries and concerns have been raised regarding possible negative fetal outcomes connected with its use, although such concerns are not supported by experimental evidence [ 47 ].…”

Prospective observational study on prescribing pattern of infertility treatment options and their success rates in women with polycystic ovary syndrome at tertiary care teaching hospital

“…[30][31][32] Ovulation inducing drugs such as letrozole and CC are the 1 st line choice of pharmacological agents used to induce ovulation and are administered at a dose of 2.5-7.5 mg/day beginning on 3-7 days and at dose of 50-150 mg/day beginning on 2-5 days of menstrual cycles respectively. 13,[20][21][22][23] Patients are said to have/be letrozole or CC failure or resistant when either letrozole or CC fail to result in pregnancy respectively. Synthetic or exogenous gonadotropins such as human chorionic gonadotropin or hCG are preferred 2 nd line choice of pharmacological agents in treating infertility when ovulation induction drugs fail and when a woman opts for IUI technique.…”

“…CC and letrozole either given alone or in combination with metformin or myo-inositol serves as the first line choice of treatment and has shown to have beneficial aspects in treating infertility. [20][21][22][23] Recombinant follicle stimulating hormone and human chorionic gonadotropin are the exogenous gonadotropins are preferred as second line choice of infertility treatment in PCOS women when treatment with ovulation induction drugs fail or in patients who ovulated but failed to conceive or in those women who are opting for IUI technique. 14 Intrauterine insemination or IUI also referred as artificial insemination is a technique used alone or in combination with ovulation inducing agents or gonadotropins.…”