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Letrozole Leads to Higher Live-Birth Rates Than Clomiphene in Women with PCOS — Physician’s First Watch

Medical News |
July 10, 2014

Letrozole Leads to Higher Live-Birth Rates Than Clomiphene in Women with PCOS

By Robert W. Rebar, MD

Edited by Susan Sadoughi, MD, and Lorenzo Di Francesco, MD, FACP, FHM

In women with polycystic ovary syndrome (PCOS), the aromatase inhibitor letrozole is associated with higher rates of live birth than clomiphene citrate, the current first-line fertility treatment for such women, according to a study in the New England Journal of Medicine.

Roughly 750 women with PCOS and ovulatory dysfunction were randomized to receive daily clomiphene citrate or letrozole for up to five cycles.

Women who received letrozole had higher cumulative rates of ovulation (62% vs. 48%) and live birth (28% vs. 19%) than those who received clomiphene. Likelihood of pregnancy loss or twin pregnancy didn't differ significantly between groups. Five neonates had major congenital abnormalities, but the overall risk was not significantly different. Letrozole was associated with higher incidence of fatigue and dizziness, and clomiphene with more hot flashes.

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).

Dr. Rebar is an associate editor with NEJM Journal Watch Women's Health, from which this story was adapted.

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