Use of Letrozole for Infertility Controversial: Letrozole is best known as the breast cancer drug Femara. Femara is used as a hormone therapy for breast cancer following surgery, to reduce the odds of a breast cancer recurrence in women with hormone receptor positive cancer (the most common type). Since 2001, the breast cancer medication has also been prescribed to treat infertility in women. Letrozole is an aromatase inhibitor. Aromatase is an enzyme that is responsible for the production of estrogen in the body. Letrozole suppresses aromatase, thereby suppressing estrogen production. As a result, the pituitary gland releases more of the hormones (FSH and LH) needed to stimulate ovulation. Clomiphene citrate (clomid) was the drug of choice to induct or increase ovulation for many years. Many fertility specialists came to prefer letrozole price over clomiphene because letrozole has a much shorter action time in the body, resulting in less letrozole side effects. Women using letrozole for fertility also experience fewer miscarriages and multiple births than those using other fertility drugs. In comparison, clomiphene citrate lasts for a long time in the body, which may have a negative effect on the cervical mucus and uterine lining. In addition, women with polycystic ovary syndrome (PCOS) do not respond well to the fertility drug. However, controversy arose with a Canadian study presented at the American Society of Reproductive Medicine 2005 Conference suggested that letrozole may increase the risk of birth defects in women who took the drug while they were pregnant. The study results led letrozole’s manufacturer, Novartis, to issue a warning that there were reported cases of birth defects associated with use of the drug while pregnant (something already mentioned on the drug’s label in the US). The study was criticized for its limited size, for the lower than normal measuring stick for birth defects, for not being a controlled double-blind placebo study, and for an “apples and oranges” control group which compared younger women who conceived spontaneously with women undergoing fertility treatments, who are statistically more likely to have children with birth defects. Fertility experts stress that there are no reports of birth defects in the children of women who used to drug before becoming pregnant. The drug is usually prescribed for a five-day period, and because it is so quickly metabolized, does not have a significant effect in the body after a short period of time, such as when an embryo would be implanting. According to San Francisco’s PacificFertilityCenter, “Infertility and OBGYN professionals across the U.S.and Canadaappear to be united in agreeing that there is an undue amount of fear and controversy concerning the use of letrozole (brand name Femara) for fertility treatment.” They point to a more recent study out of Canada’s McGill University that found lower rates of birth defects in a group of women taking buy letrozole than in a group using clomiphene (3.0%) � both similar to rates found in the general population. It’s important to note that letrozole has never been FDA-approved as a fertility drug, and that the government ofIndiarecently suspended its use as for induction of ovulation. The decision to use letrozole for infertility should be made along with a health care professional who can help weigh the pros and cons.
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