The Effects of Letrozole And Clomiphene Citrate For Induction of Ovulation In Polycystic Ovarian Syndrome(PCOS) (No)
|First Received Date ICMJE||April 4, 2012|
|Last Updated Date||June 13, 2012|
|Start Date ICMJE||May 2008|
|Primary Completion Date||May 2009 (final data collection date for primary outcome measure)|
|Current Primary Outcome Measures ICMJE
||To evaluate the effectiveness of ovulation induction among PCOS patients [ Time Frame: 6 weeks ] [ Designated as safety issue: Yes ]
To evaluate the effectiveness of letrozole and clomiphene citrate for induction of ovulation in PCOS patients.
|Original Primary Outcome Measures ICMJE||Same as current|
|Change History||Complete list of historical versions of study NCT01577017 on ClinicalTrials.gov Archive Site|
|Current Secondary Outcome Measures ICMJE
||Number of patients that can ovulate and pregnant [ Time Frame: 6 weeks ] [ Designated as safety issue: Yes ]
i. ovulation rate among PCOS patients with letrozole and CC ii. endometrial thickness among patients with letrozole and CC iii. number of pregnancy between letrozole and CC iv. associated factors that can influence the effectiveness of the treatment found in age, body weight, duration of marriage, duration of infertility and types of infertility either primary or secondary among PCOS patients.
|Original Secondary Outcome Measures ICMJE||Same as current|
|Current Other Outcome Measures ICMJE||Not Provided|
|Original Other Outcome Measures ICMJE||Not Provided|
|Brief Title ICMJE||The Effects of Letrozole And Clomiphene Citrate For Induction of Ovulation In Polycystic Ovarian Syndrome(PCOS)|
|Official Title ICMJE||Study On The Effects of Letrozole And Clomiphene Citrate For Induction of Ovulation In Polycystic Ovarian Syndrome(PCOS)|
As both medications i.e. CC and letrozole have been shown to be effective in inducing ovulation in PCOS patients, this study was performed in order to evaluate which regime (whether CC or letrozole) is the best to be used as the first line treatment for PCOS patients with infertility for local population. The best regime will therefore could be included in the protocol of management of infertility patients with PCOS so that the quality of patients' care could be improved.
Polycystic Ovarian Syndrome (PCOS) is the most common endocrinopathy among women of reproductive age group and is one of the leading causes of infertility. It is characterized by chronic anovulation and hyperandrogenism with variable clinical manifestations that include oligomenorrhea, infertility, hirsutism, and acne (Ehrmann DA 2005).
Several methods have been described to induce ovulation in PCOS patients- weight reduction, laparoscopic ovarian drilling and the use of various induction ovulation agents like clomiphene citrate (CC), aromatase inhibitors (AIs) and gonadotrophins.
Clomiphene citrate (CC) has been most widely used and standard drug for the treatment of infertility. It is known that clomiphene citrate results in an ovulation rate of 60-85%, but a conception rate of only around 20% (Bayar et al 2006, Sohrabvand et al 2006). About 20-25% of women are resistant to CC and do not ovulate. Discrepancy between ovulation and pregnancy rate is related to anti-estrogenic activity on endometrium and cervical mucus is due to CC has a long half life of 5 to 7 days.
In view of disappointing result of CC treatment with many adverse effect and cost and possible complication of gonadotrophin, the concept of aromatase inhibition was proposed as a new method of ovulation that are easy to use, less expensive and more effective drugs.
Letrozole is an oral, potent, reversible, and highly selective aromatase inhobitor that prevent androgen-to-estrogen (E) conversion. These aromatase inhibitors have a short half life (45 hours), hence is rapidly eliminated from the body. No adverse effect on E target tissues is seen with letrozole due to this short half life; furthermore, it does not down regulate the ER compare to CC.
The main impetus for the development of aromatase inhibitor as ovulation induction agents was to avoid the peripheral antiestrogenic effects of CC, especially the frequent occurrence of a thin endometrial lining (Sohrabvand et al 2006).
Rationale of performing the study As both medications i.e. CC and letrozole have been shown to be effective in inducing ovulation in PCOS patients, this study was performed in order to evaluate which regime (whether CC or letrozole) is the best to be used as the first line treatment for PCOS patients with infertility for local population. The best regime will therefore could be included in the protocol of management of infertility patients with PCOS so that the quality of patients' care could be improved.
Letrozole is more effective than clomiphene citrate as ovulation agent in PCOS patients.
General Objective To compare the effectiveness of letrozole and clomiphene citrate as ovulation agent in PCOS.
i. To identify the ovulation percentage between letrozole and CC ii. To compare the endometrial thickness between letrozole and CC iii. To determine the pregnancy outcome between letrozole and CC iv. To study the associated factors that can affect the effectiveness of the treatment e.g. age, body weight, smoking, duration of marriage, duration of infertility and types of infertility either primary or secondary)
1.0 Study design
Prospective, multicenter, randomized control trial.
2.0 Population and sample
The reference population will be the female patient diagnosed to have polycystic ovarian syndrome at infertility clinic HSB, Kedah and infertility clinic HUSM, Kelantan and infertility Clinic, Hospital Tengku Ampuan Afzan (HTAA), Kuantan, Pahang.
3.0 Selection criteria 3.1 Inclusion criteria i. Age > 18 years but < 40 years old ii. Was diagnosed PCOS iii. Patient is not illiterate. iv. Normal husband's seminal fluid analysis (SFA) - (Count > 20 million/ml, Motility > 40% and normal morphology > 30%) 3.2 Exclusion criteria : i. Having medical problem eg- renal disease, tyhroid disorder, hyperprolactinemia, liver disease.
ii. Other causes of anovulatory infertility
4.0 Sampling and Sample size
4.1 Sample size
Sample size calculation:
4.2 Sampling frame All PCOS patients attending Infertility Clinic Hospital Sultanah Bahiyah (HSB), Kedah, Infertility Clinic Hospital Universiti Sains Malaysia (HUSM), Kelantan and Infertility Clinic Hospital Tengku Ampuan Afzan (HTAA), Kuantan, Pahang who fulfill inclusion and exclusion criteria will be recruited in the study.
5.0 Methods of data collection
The study will be conducted after the approval from Hospital Sultanah Bahiyah, Kedah, USM and HTAA, Pahang ethical committee.
All PCOS patients, age more than 18 years old at Gynecology Clinic, HUSM were given information form regarding the study conducted. When the participants agree to involve in this study, the consent form will be given to them. Participants are required to fill the social demographic data which includes age, address, occupation, monthly family income, education status, and duration of marriage, number of parity and year of last child birth. Measurement such as waist circumference, weight, height and blood pressure reading will be recorded. Then patients will be randomized into two groups
Randomization PCOS women who are eligible and fulfilling the criteria of the study will recruit. After they had given inform consent, they will assigned to one of the groups of sealed opaque envelope labelled as C and L. Women in group C will assigned CC 100mg and those in L assigned Letrozole 2.5 mg. The randomization will be done by computer- generated randomization using http://www.randomization.com according to the random sequence.
Group 1- Letrozole group
Group 2 Clomiphene Citrate Group
In all groups a urine pregnancy test was done 3 weeks after documented ovulation and the patient remained amenorrheic. All study medications will be discontinued when there was a positive pregnancy test. Pregnant patients were then will be followed up until an ultrasound could document the viability of pregnancy. Copies of patients' obstetric records, including delivery records, were reviewed by the investigators to obtain obstetrics outcomes e.g: miscarriage, ectopic pregnancy, molar pregnancy, preterm delivery etc).
|Study Type ICMJE||Interventional|
|Study Phase||Phase 3|
|Study Design ICMJE||Endpoint Classification: Efficacy Study
Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
|Condition ICMJE||Polycystic Ovarian Syndrome|
|Intervention ICMJE||Drug: Letrozole
Women in group L will be assigned with Letrozole on night at day 5 to day 9 of the cycle
Other Name: Femara (Aromatase Inhibitor)
|Study Arm (s)||Experimental: Letrozole
Group L will be assigned with Letrozole 5 mg on night on day 5 to day 9 of the cycle
Intervention: Drug: Letrozole
|Publications *||Not Provided|
* Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
|Recruitment Status ICMJE||Completed|
|Completion Date||March 2012|
|Primary Completion Date||May 2009 (final data collection date for primary outcome measure)|
|Eligibility Criteria ICMJE||
Exclusion criteria :
|Ages||19 Years to 39 Years|
|Accepts Healthy Volunteers||Yes|
|Contacts ICMJE||Contact information is only displayed when the study is recruiting subjects|
|Location Countries ICMJE||Not Provided|
|NCT Number ICMJE||NCT01577017|
|Other Study ID Numbers ICMJE||PCOS- Letrozole vs Clomid|
|Has Data Monitoring Committee||Yes|
|Responsible Party||Nik Hazlina, University of Science Malaysia|
|Study Sponsor ICMJE||Nik Hazlina|
|Collaborators ICMJE||Not Provided|
|Investigators ICMJE||Not Provided|
|Information Provided By||University of Science Malaysia|
|Verification Date||June 2012|
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