Comparison of the efficacy of letrozole stair-step protocol with clomiphene citrate stair-step protocol in the management of clomiphene citrate-resistant polycystic ovary syndrome patients

Sakar M. N. , Oğlak S. C.

Journal of Obstetrics and Gynaecology Research, vol.47, no.11, pp.3875-3882, 2021 (SCI-Expanded) identifier identifier identifier

  • Publication Type: Article / Article
  • Volume: 47 Issue: 11
  • Publication Date: 2021
  • Doi Number: 10.1111/jog.14936
  • Journal Name: Journal of Obstetrics and Gynaecology Research
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus, Academic Search Premier, CINAHL, EMBASE, MEDLINE
  • Page Numbers: pp.3875-3882
  • Keywords: hyperandrogenism, menstrual disorders, ovarian function, polycystic ovary syndrome, WOMEN, INFERTILITY, PCOS
  • Gazi University Affiliated: No


© 2021 Japan Society of Obstetrics and Gynecology.Purpose: We sought to compare the efficacy of the letrozole (LTZ) stair-step protocol with clomiphene citrate (CC) stair-step protocol in the management of 150 mg dose of CC-resistant polycystic ovary syndrome (PCOS) patients. Methods: We retrospectively compared a total of 61 patients diagnosed as being resistant to the traditional CC protocol who were subsequently managed using the LTZ stair-step protocol with CC-resistant 56 patients who were treated with CC stair-step protocol. The number of follicles ≥18 mm, endometrial thickness, time to ovulation, clinical pregnancy rates, multiple pregnancy rates, spontaneous abortion rates, live birth rates, and systemic side effects in patients were evaluated. Results: The mean time to ovulation was significantly shorter in the LTZ stair-step group than the CC stair-step group (17.3 ± 7.7 and 22.4 ± 8.1 days, respectively, p < 0.001). The ovulation rate was significantly higher in patients treated with LTZ stair-step protocol than those treated with the CC stair-step protocol (83.6% and 64.2%, respectively, p = 0.007). The clinical pregnancy rate was higher in the LTZ stair-step than the CC stair-step group (32.7% and 17.8%, respectively, p = 0.015). LTZ stair-step group had a significantly higher live birth rate than that of the CC stair-step group (27.8% and 14.2%, respectively, p = 0.012). Conclusion: The LTZ stair-step protocol revealed higher ovulation, clinical pregnancy, and live birth rates with a shorter time to achieve ovulation than the CC stair-step protocol. Increment of the dose in the same cycle in both protocols did not cause any additional severe side effects.