When considering treatment for-non-ovulating women with normal pituitary hormones, a decision must be made about which type of drug to use to enhance the chances of success: oral agents like CLOMID® (clomiphene citrate) or FEMARA® (letrozole) or injectables represented by a variety of gonadotropins, MENOPUR® (menotropins for injection), GONAL-F® (follitropin alfa for injection), BRAVELLE® (urofollitropin), and FOLLISTIM® (follitropin beta injection). If an oral agent is selected the question becomes how many cycles to try before moving on.
Switching to gonadotropins increased the odds of live births for women with normogonadotropic anovulation with little success for continuing with clomifene citrate, based on data from 666 women. In a study published online in the Lancet, the researchers randomized 166 women to gonadotropins and intrauterine insemination, 165 to gonadotropins and intercourse, 163 to clomifene citrate and intrauterine insemination, and 172 to clomifene citrate and intercourse. The study population included women aged 18 years and older who had not become pregnant after six cycles of clomifene citrate. The clomifene citrate was given as oral doses of 50-150 mg daily, and gonadotropin was given subcutaneously at a starting dose of 50 IU or 75 IU daily.
Overall, live births were significantly more likely for women given gonadotropins, compared with those given clomifene citrate (52% of 327 women vs. 41% of 334 women, respectively). Rates of multiple pregnancies were similar and relatively low among the treatment groups.
Intrauterine insemination had no significant impact on live birth rates, compared with intercourse (49% vs. 43%, respectively).
The decision of which type of treatment to use is between a patient and her doctor and depends on a balance of effectiveness, expense and safety of each type of treatment. This study adds weight to the effectiveness factor for injectables, but they are more expensive, require injections and are more likely to result in multiple pregnancy and hyperstimulation. Oral agents are less intense, less expensive and less likely to result in multiple pregnancy (10%, almost all twins) and hyperstimulation. But according to this study, less likely to result in a live birth.