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Letrozole or Clomiphene for Infertility in the Polycystic Ovary Syndrome

Legro et al. report that treatment with letrozole was superior to treatment with clomiphene in terms of higher live-birth and ovulation rates among infertile women with the polycystic ovary syndrome. We wonder whether serum prolactin levels were evaluated at baseline and throughout the study. The polycystic ovary syndrome and hyperprolactinemia are both common causes of infertility in women. Up to 64% of women with mild hyperprolactinemia fulfill the modified Rotterdam diagnostic criteria for the polycystic ovary syndrome.1 Therefore, we believe that it is mandatory to measure serum prolactin levels when assessing the cause of infertility, even if the patient has the polycystic ovary syndrome. Furthermore, it is important to elucidate the cause of hyperprolactinemia and to assess the need for treatment with dopamine agonists.2 In addition, there is some evidence that letrozole regulates the expression of pituitary prolactin and luteinizing hormone and affects serum prolactin levels.3 Serum prolactin positively correlates with insulin resistance, which has an important role in the pathogenesis of the polycystic ovary syndrome. Hence, the superiority of letrozole over clomiphene in the current study might be explained by the effect of letrozole on serum prolactin levels.

Letrozole, Clomiphene, Infertility, Polycystic Ovary Syndrom

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