Combination Letrozole and Clomiphene Citrate Versus Letrozole Alone

Last updated: July 11, 2024
Sponsor: Egymedicalpedia
Overall Status: Active - Recruiting

Phase

N/A

Condition

Reproductive Health

Polycystic Ovarian Syndrome

Treatment

Letrozole 2.5mg

Clinical Study ID

NCT06507332
Mohamed Adel Mousa
  • Ages 20-35
  • Female

Study Summary

Clomiphene citrate is a non-steroidal triphenylethylene derivative distantly related to diethylstilbestrol. It acts as a selective estrogen receptor modulator (SERM), similar to tamoxifen and raloxifene. All three drugs are competitive inhibitors of estrogen binding to estrogen receptors (ERs) and have mixed agonist and antagonist activity, depending upon the target tissue.

Letrozole is a potent, nonsteroidal, aromatase inhibitor, originally used for postmenopausal breast cancer therapy.

Eligibility Criteria

Inclusion

Inclusion Criteria:

  • Diagnosis of infertility, defined as the inability of couple to achieve a pregnancyafter 12 months of regular timed unprotected intercourse in women <35 years of ageor after 6 months in women >35 years of age.

  • Diagnosis of PCOS based on the Rotterdam criteria, including two of the followingthree findings: oligomenorrhea or chronic anovulation, hyperandrogenism (clinical orlaboratory), and polycystic ovary(ies) on ultrasound .

  • Normal HSG

  • Normal semen analysis.

  • Has capacity to participate in the study.

Exclusion

Exclusion Criteria:

  • Unexplained infertility.

  • Other conditions that can cause chronic anovulation and androgen excess such ashyperthyroidism by thyroid profile.

  • congenital adrenal hyperplasia

  • Cushing

  • Untreated hyperprolactinemia.

  • Medical conditions not well controlled or contraindicated to get pregnant with itlike (uncontrolled diabetes mellitus, hypertension) .

  • endometrial hyperplasia/cancer

  • Allergy or contraindications to letrozole or CC. (by history)

Study Design

Total Participants: 64
Treatment Group(s): 1
Primary Treatment: Letrozole 2.5mg
Phase:
Study Start date:
March 01, 2024
Estimated Completion Date:
September 10, 2024

Study Description

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in reproductive-age women and the most common cause of anovulatory infertility. The treatment of infertility in patients with PCOS focuses on ovulation induction. Many treatment regimens have been used, with varying success, to achieve ovulation, pregnancy, and live birth.

Clomiphene citrate (CC) is a commonly prescribed pharmacologic agent used to induce ovulation in women with PCOS. It works as a selective estrogen receptor modulator by competitively attaching to nuclear estrogen receptors. As the negative feedback of estrogen is reduced, secretion of gonadotropin hormones increases, inducing ovarian follicular growth.

Clomiphene citrate (CC) also has an anti-estrogenic effect on endometrial development and cervical mucus production,which has been suggested to contribute to a relatively low pregnancy rate despite a high ovulation rate.

Letrozole is another commonly used oral ovulation induction agent, with a different mechanism of action. It works as a highly selective aromatase inhibitor, preventing androgen-to-estrogen conversion. One proposed mechanism is via suppressed estrogen production resulting in decreased negative feedback on the hypothalamus and increased secretion of Follicular Stimulating Hormone (FSH). An additional proposed mechanism of improved ovulatory rates with the use of letrozole is increased follicular sensitivity to FSH resulting from temporarily increased intraovarian androgens .

Letrozole may offer a benefit over CC for ovulation induction because it does not block estrogen receptors in both central and peripheral target tissues, and normal central feedback mechanisms remain intact. The Pregnancy and Polycystic Ovary Syndrome (PPCOS) trial, a randomized controlled trial comparing letrozole and CC, demonstrated that letrozole was associated with a higher live birth rate (27.5% vs. 19.1%; P=007; rate ratio 1.44, 95% confidence interval [CI] 1.10-1.87) and cumulative ovulation rate (61.7% vs. 48.3%; P<.001) among women with PCOS.

Other than letrozole or CC for ovulation induction, there are few treatment options available to PCOS patients except proceeding to gonadotropin injections or in vitro fertilization, both of which are associated with increased cost and risk.

Connect with a study center

  • Ain Shams University Hospitals

    Cairo, Abbasia
    Egypt

    Active - Recruiting

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