Evaluating the effectiveness of letrozole/gonadotropin protocol in infertile women with PCOS

The study compared the effectiveness of letrozole (Femara)/gonadotropin combination to letrozole alone in infertile women with polycystic ovarian syndrome (PCOS). The study found that the combination of letrozole/gonadotropin was more effective than letrozole alone in these women.

Polycystic ovarian syndrome or PCOS is a hormonal disorder that can cause women not to ovulate regularly. This can reduce the chance of women to become pregnant. Ovulation induction is the main treatment in PCOS for women with fertility issues. Ovulation induction helps to stimulate follicle growth and development. There are many available therapies for ovulation induction such as clomiphene citrate (Clomid), aromatase inhibitors, and gonadotropins. Each therapy has its own benefits and risks.

Recently, letrozole, an aromatase inhibitor has become the first-line treatment for ovulation induction. The mechanism of letrozole proves to be effective with minimal side effects. Letrozole gives a single dominant follicle and a lower risk of developing ovarian hyperstimulation syndrome (OHSS; a complication of ovarian stimulation that can lead to loss of the ovary). Additionally, human menopausal gonadotropin (HMG; Menopur) is also known to be used for ovulation induction. However, HMG gives multiple follicle development and a higher risk of developing OHSS.

The main aim is to achieve single pregnancy with a lower risk of OHSS and other possible complications. A few research studies have shown positive outcomes of injecting HMG after the use of letrozole or other similar drugs. This has proven to give good clinical pregnancy rates with lower complication risks. However, whether the combination of letrozole/gonadotropin is better than letrozole alone is still unknown.

The study involved 174 infertile women with PCOS. Patients were randomly assigned to either a letrozole-only group (87 patients; group 1) or the letrozole/gonadotropin group (87 patients; group 2). 2.5 mg of letrozole was given to each group on cycle days 3-7. Group 2 also received 75 IU HMG on cycle days 8-10 after receiving letrozole.

The ovulation rate was higher in group 2 (90.8%) compared to group 1 (70.1%). The live birth rate was also higher in group 2 (23%) compared to group 1 (10.3%).

There was no statistical difference between groups in side effects such as OHSS, multiple pregnancies, miscarriages, or drug side effects.  

The study concluded that the letrozole/gonadotropin protocol gave better results in ovulation induction and pregnancy outcomes than letrozole alone in infertile women with PCOS. 

The lowest initial dose of letrozole was used. More research is needed to test with higher doses of letrozole. Additionally, the study was done in China only and does not reflect the general population. More studies are needed to validate the findings.