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Article: Femara Better than Clomid for Women with PCOS?
letrozole leads to higher live-birth rates than clomiphene in women with pcos
Study results indicate that the aromatase inhibitor letrozole should be the first-line treatment for infertility associated with polycystic ovary syndrome.
Clomiphene citrate has long been the first-line fertility treatment for anovulatory women (including those with polycystic ovary syndrome [PCOS]). This selective estrogen-receptor modulator antagonizes estrogen's negative feedback on the hypothalamus, resulting in increased secretion of gonadotropin-releasing hormone and, ultimately, stimulation of follicular development. However, clomiphene has drawbacks (e.g., high rates of failure and multiple pregnancies) and adverse effects (e.g., hot flashes, mood changes, visual disturbances). Aromatase inhibitors affect hypothalamic-pituitary-ovarian function by blocking estrogen synthesis and might be more effective for achieving pregnancy. NIH-supported investigators conducted a double-blind, multicenter, randomized trial involving 750 women with PCOS and ovulatory dysfunction. Participants received clomiphene citrate (50 mg daily) or the aromatase inhibitor letrozole (2.5 mg daily) for up to 5 cycles. Doses were escalated (up to 150-mg clomiphene and 7.5-mg letrozole) if ovulatory response was poor or absent.
Women who received letrozole had higher cumulative rates of ovulation (62% vs. 48%; P<0.001) and live birth (28% vs. 19%; P=0.007) than those who received clomiphene. Likelihood of pregnancy loss (32% vs. 29%) or twin pregnancy (3% vs. 7%) did not differ significantly between groups. Overall risk for congenital anomalies also did not differ significantly, although 4 of 102 neonates in the letrozole group and 1 of 66 in the clomiphene group had major congenital anomalies (P=0.65). Letrozole was associated with higher incidence of fatigue and dizziness, and clomiphene with more hot flashes.
COMMENT
In showing letrozole's strengths as a first-line treatment for infertile women with PCOS, these data should transform the treatment of such women (although letrozole is not FDA approved for this indication and is not yet likely to be covered by insurance for such use). The study did not address anovulation from other causes, so it remains unknown whether this aromatase inhibitor has broader superiority over clomiphene for inducing ovulation. In addition, the trial was insufficiently powered to determine if letrozole raises risk for congenital anomalies (which will require further study involving thousands of women). Letrozole is unlikely to increase this risk more than clomiphene because its half-life is much shorter than clomiphene's; moreover, the anomaly rates in both treatment groups were similar to those in the general population (5.8% of spontaneously conceived pregnancies; N Engl J Med 2012; 366:1803).
B/w 1/8: betas 17,345, progesterone 25.6
Re: Article: Femara Better than Clomid for Women with PCOS?
In Christ alone my hope is found. He is my LIGHT, my STRENGTH, and my SONG!
T-TTC since Dec 2008. PCOS/nonexistant cycles(anovulation) and endo. HSG in '10 revealed both tubes blocked. Lap surgery in Dec '10 to correct. Failed Clomid/IUI and injectable(Bravelle)/IUI cycles so far.
B/w 1/8: betas 17,345, progesterone 25.6
I wish... They're just trying to cover their butts simply because it's not FDA approved for infertility. I can see it from their side and totally understand that reasoning, but it's also frustrating to be in my position in that I only did Clomid twice (and it only worked once) and can't do it again, so my only options are MUCH more expensive and potentially even cost prohibitive.
That said, if our next and last injectables cycle fails (whenever that is), we're considering finding a new clinic that does to Femara vs going straight to IVF, which I don't think we can afford to do anyway.
In Christ alone my hope is found. He is my LIGHT, my STRENGTH, and my SONG!
T-TTC since Dec 2008. PCOS/nonexistant cycles(anovulation) and endo. HSG in '10 revealed both tubes blocked. Lap surgery in Dec '10 to correct. Failed Clomid/IUI and injectable(Bravelle)/IUI cycles so far.
B/w 1/8: betas 17,345, progesterone 25.6
~TTC Buddies with akcrrr and amandaf6383~
Natural Cycle (8/7/13)- BFP! Beta #1 (9/10/13): 509 Progesterone: 18.64 Beta #2 (9/12/13): 1118
Same here. Well, I did respond once we got up to 150mg, but that was it. I had great responses to letrozole.
08/13: Started TTC - 07/14: PCOS dx
BFP 09/18/15 - Baby S 05/27/16
TTC#2 4/14
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