Wednesday, December 27, 2017

Stair-step ovulation induction protocols are not just limited to Clomiphene


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.


13 comments:

  1. 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
    laparoscopic 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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  2. The 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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