An assessment of current clinical attitudes toward letrozole use in reproductive endocrinology practices

Capsule:
A survey of SART clinic members reveals that 77% of respondents use letrozole in clinical practice. The majority of letrozole is used in patients who fail to ovulate with clomiphene citrate.

Authors:
Alice Rhoton-Vlasak, M.D., Lindsay Malloch, M.D.

Volume 100, Issue 6, Pages 1740-1744, December 2013

Abstract:

Objective:
To assess the clinical use and practice attitudes among Society for Assisted Reproductive Technology (SART) members regarding the use of letrozole for ovulation induction and infertility treatment.

Design:
The SART clinic physicians were mailed a cover letter and consent form, a two-page survey, and return envelope. The surveys were returned and analyzed using descriptive statistics.

Setting:
Not applicable.

Patient(s):
None.

Intervention(s):
A 13-question survey.

Main Outcome Measure(s):
Reproductive endocrinology and infertility physicians use patterns and attitudes regarding letrozole.

Result(s):
A total of 77.9% of physician prescribe letrozole. Of those who do not, 32.4% cited concern about the US Food and Drug Administration warning, 35.1% cited satisfaction with current medications, 25.7% cited both reasons, and 6.8% cited no experience with letrozole. Physicians (11.5%) were unaware of the US Food and Drug Administration warning. Physicians (99.7%) were aware that ovulation induction is an off-label use of letrozole. The most common use was for ovulation induction in patients with polycystic ovary syndrome (PCOS). Physicians (14.9%) prescribe letrozole as first-line ovulation therapy prior to clomid, 47.9% use for clomid failures, and 25.7% reported use in both situations.

Conclusion(s):
Most physicians surveyed use letrozole for ovulation induction despite the current US Food and Drug Administration warning. Even when accounting for nonrespondents, more than 25% of physicians indicated success with letrozole use. Questions regarding doses and clinical concerns about letrozole revealed no standardized manner of letrozole administration despite wide interest, therefore additional research is warranted.

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