Polycystic ovary syndrome (PCOS) is one of the most common causes of infertility in women. The drug, Clomid (clomiphene), is available to increase the chance of pregnancy among PCOS sufferers, but some women do not respond. A new study compared Clomid to Femara (letrozole), manufactured by Novartis, and found it to be superior. The study was published on July 10 in The New England Journal of Medicine by a consortium of academic institutions known as the National Institute of Child Health and Human Development Reproductive Medicine Network (NICHD).
The study authors note that their results offer the best evidence to date that Femara may be more effective than Clomid; thus, their findings may fuel a shift in infertility treatment for PCOS sufferers. They note that the medication adds another inexpensive treatment for infertility among these women. For the study, the women were divided into two groups; one group received Clomid and the other received Femara. The women in both groups were given increasing doses of Clomid or Femara for up to five cycles. The women in the Femara group had a significantly higher cumulative live birthrate (27.5%), compared to that of the Clomid group (19.1%; the Femara group had 31 more live births than the Clomid group.
Another positive finding of the study was that no significant difference in the number of side-effects or birth defects in either group. Four cases of birth defects occurred in the Femara group and one occurred in the Clomid group; however, there were more pregnancies in the Femara group.
Femara is Food and Drug Adminstration (FDA)-approved to treat breast cancer; however, it is used off-label for ovarian stimulation. The authors note that concerns have been raised regarding whether Femara increases the risk of a birth defect. They note that the issue has been addressed in unpublished data and that their findings offer a degree of reassurance regarding its safety. However, the safety issue has not been completely resolved. Thus, further studies regarding its safety should be conducted.
According to the American College of Obstetrics and Gynecology (ACOG), common PCOS signs and symptoms include the following:
- Irregular menstrual periods: Menstrual bleeding may be absent, heavy, or unpredictable.
- Lnfertility: PCOS is one of the most common causes of female infertility.
- Obesity: Up to 80% of women with PCOS are obese.
- Excess hair growth on the face, chest, abdomen, or upper thighs; this condition, which is called hirsutism, affects more than 70% of women with PCOS.
- Severe acne or acne that occurs after adolescence and does not respond to usual treatments
- Oily skin
- Patches of thickened, velvety, darkened skin called acanthosis nigricans
- Multiple small cysts on the ovaries
The cause of PCOS is not known, it appears that PCOS may be related to many different factors working together. These factors include insulin resistance, increased levels of androgens, and an irregular menstrual cycle.