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Induz in Ovulation Induction
Dr Sujoy Dasgupta
MBBS (Gold Medalist, Hons) MS (Obst & Gynae- Gold Medalist)
DNB, FIAOG, Fellow- Reproductive Endocrinology and Infertility (ACOG, USA)
Assistant Professor: SRIMSH, Durgapur
Consultant:
RSV Hospital, Kolkata
Iris Hospital, Kolkata
Behala Balananda Brahmachary Hospital, Kolkata
Secretary, Perinatology Committee: Bengal Obstetric and Gynaecological Society (BOGS)- 2016-17
Managing Committee Member: BOGS- 2016-17
15 Publications: National and International Journals
NOTICE
Medicine is an ever-changing science. As new research and clinical
experience broaden our knowledge, changes in treatment and drug
therapy are required. The authors and the publisher of this work have
checked with sources believed to be reliable in their efforts to provide
information that is complete and generally in accord with the standards
accepted at the time of publication. However, in view of the possibility of
human error or changes in medical sciences, neither the authors nor the
publisher nor any other party who has been involved in the preparation or
publication of this work warrants that the information contained herein is in
every respect accurate or complete, and they disclaim all responsibility for
any errors or omissions or for the results obtained from use of the information
contained in this work. Readers are encouraged to confirm the information
contained herein with other sources.
Incidence of all malformations was not different between
the two groups (p= 0.25, 95%CI 0.78-4.71).
However, the incidence of locomotor malformations (p= 0.0005, 95% CI
2.64-27.0) and cardiac anomalies (p= 0.0006 95% CI 3.30-58.1) were
higher than in the control groups
Fertil Steril. 2006 Jun;85(6):1761-5
No difference in overall rates of major & minor congenital
malformations among newborns from mothers who conceived after
LTZ or CC treatments
It appears that congenital cardiac anomalies are less frequent in LTZ
group
The concern that LTZ use for ovulation induction could be
teratogenic is unfounded based on this data
Number of newborns with major malformations
Percent of newborns with malformations
Hum Reprod. 2017 Jan;32(1):125-132
N= 3928
LTZ stimulation reduces risk of miscarriage, with no increase in risk of major
congenital anomalies or adverse pregnancy
Sharma S, et al. PLoS ONE. 2014; 9(10): e108219
Structural malformations &
chromosomal abnormalities
N= 623
Natural conception group
5 / 171 babies
(2.9%)
LTZ group5 / 201 babies
(2.5%)
CC group10 / 251 babies
(3.9%)
Other Studies
Reference No of patients
Forman R, et al. J Obstet Gynaecol Can 2007;29:668-71. 430
Dehbashi S, et al. Iran J Med Sci 2009;34:23-8. 100
Legro RS, et al. N Engl J Med. 2014 Jul 10;371(2):119-29. 750
Banerjee Ray P, et al. Arch Gynecol Obstet. 2012 Mar;285(3):873-7. 147
Roy KK, et al. J Hum Reprod Sci. 2012 Jan-Apr; 5(1): 20–25 204
Wu XK, et al. Fertil Steril 2016;106:757-765 644
Requena A, et al. Hum Reprod Update. 2008 Nov-Dec;14(6):571-82.
(Meta-analysis)
2573
Diamond MP, et al. N Engl J Med 2015;373:1230-40. 900
Wang R, et al. BMJ. 2017; 356: j138.
15th Jan 2017
Ban On Letrozole Lifted After 5 Long Years By DCGI
13
Letrozole Revoked
MINISTRY OF HEALTH AND FAMILY WELFARE [(Department of Health and
Family Welfare) NOTIFICATION: New Delhi, the 17th February, 2017 G.S.R. 145(E)]
Current Clinical Guidelines
For women with PCOS and BMI >30, letrozole should be
considered as first-line therapy for ovulation induction
because of the increased live birth rate compared with
clomiphene citrate
Endocrine Society Clinical Guideline (2013) recommends:
Clomiphene citrate (or comparable estrogen modulators such as
Letrozole) as the first-line treatment of anovulatory infertility in women
with PCOS.
American Association of Clinical Endocrinologists, American College of
Endocrinology, And Androgen Excess & PCOS Society (2015)
Treatment for women with PCOS and anovulatory infertility should
begin with an oral agent such as clomiphene citrate or Letrozole, an
aromatase inhibitor.
CC should be first-line pharmacotherapy for ovulation induction and letrozole can also be
used as first-line therapy.
Letrozole as
Ovulation
Inducer
Clomiphene Citrate
Ovulation: 70-80% cases
Pregnancy rate: 10-20%/cycle*
not more then 6 cycle continuously and not more then 12 cycles in life time
..to avoid possible Risk of (?) Ovarian Malignancy (NICE, 2013)
In doses of 50 mg/d /cycle and can be increased to 150 mg until ovulation is achieved