Vaginal Progesterone Supplementation in Women With PCOS Undergoing Ovulation Induction With Letrozole
Status:
Completed
Trial end date:
2017-12-30
Target enrollment:
Participant gender:
Summary
Aromatase inhibitors such as letrozole are hypothesized to maintain normal hypothalamic/
pituitary feedback mechanisms and in the case of OI (ovulation induction) in women with PCOS,
may act to increase follicular sensitivity to FSH by increasing intrafollicular androgen
levels. Letrozole also may act to increase midluteal P levels presumably by induction of
follicles and corpora lutea. The investigators are asking the question whether P
supplementation with Crinone (8%) may have an additive beneficial effect on endometrial
development in those women taking letrozole. Progesterone levels in the endometrium (tissue
levels) have been documented to be significantly higher than serum levels after vaginal
administration which may lead to higher pregnancy rates. In addition P has been shown to
decrease LH pulse frequency which is elevated in PCOS and has been shown to down regulate
endometrial androgen receptors. There have been retrospective studies showing progesterone
supplementation seems to benefit both CC and letrozole treatment groups. In fact, this study
showed the only pregnancies in the letrozole group were those in women who took P
supplementation. However the number of cycles studied was small. There is a place for a
randomized controlled trial (RCT) to determine if luteal phase P supplementation with Crinone
should be used in all women using letrozole for Ovulation Induction (OI) in combination with
Intrauterine Insemination (IUI) or Timed Intercourse (TI). This is currently not done in all
clinical practices.