Stair-step ovulation
induction protocol with Letrozole is also as effective as stair-step method
using Clomiphene Citrate, and has a slight edge over CC in obese patients reports
the result of study published in March issue of Fertility and Sterility.
Stair-step ovulation
induction protocols have shown to achieve ovulation induction in shorter time
as compared to traditional protocols in women with PCOS. But, so far studies
and clinical trials have mainly focused on Clomiphene Citrate(CC).
Letrozole
has shown to have superior ovulation rates over CC in women with PCOS, but no
study has so far evaluated the stair-step method for Letrozole in cases of
absent follicular recruitment after the initial dose.
This Retrospective cohort study
recruited 92 infertile PCOS patients, 49 patients completed a letrozole
stair-step from Jan 2015-Oct 2016 while 43 patients received stair-step protocols from July 2013-2014.
 |
| Letrozole protocol used in the study |
 |
| CC protocol used in the study |
The demographics of both the groups
were nearly similar, except patients in the Letrozole group were obese with a mean
BMI of 30.8 as compared to 26.3 in CC group.
Ovulation
rates were comparable in both groups (95.9% vs 88.1%, p=0.09), as also time to
attain pregnancy, clinical pregnancy rates and side effects.
Thus, letrozole
can also be effectively used in stair-step doses for achieving ovulation and pregnancy
in PCOS women resistant to traditional protocols.
Alternatively , albeit high cost methods possibly with more ovulation rate & more acceptable preg rates:-The trial could have included oter two arms when there is a definite follicular lag as demonstrated by Follicular monitoring :-a) HMG in another arm (though the cost of treatment would have been higher). Or cancelling the cycle in favour of LOD where What I am suggesting is that like mini IVF protocol (minimal stimulation) , Treatment success after
ReplyDeletelaparoscopic electrocautery of the ovaries in women Women with a LH/FSH rate above 2 have a higher
probability to ovulate following laparoscopic electrocautery.
Ref:-“CC resistant PCOS
ovary syndrome treated with electrocautery. Bayram N. 1 , van Wely M. 1 , van der Veen F. 1 and Bossuyt P.M.M. who performed cautery and achieved higher success rates .
Department of Obstretrics and Gynaecology and 2 Department of
Epidemiology and Biostatistics, Academic Medical Center, the
Netherlands
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DeleteThe protocol in PCOS in non-ART cycle where CC resistance has been documented after two cycles of trial :-One can use Letrozole for couple of cycles(extended period-say day 3 to day 13 of menst cycle, but one can also think of another protocol B) CC + Inj r-FSH, along with follicular monitoring
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