The LEGRO trial (2014, NEJM) compared letrozole versus clomiphene citrate in PCOS-related infertility. The primary outcome of live birth rate was:
- A Equivalent between letrozole and clomiphene
- B Significantly higher with clomiphene (40.4%) than letrozole (27.5%)
- C Significantly higher with letrozole (27.5%) than clomiphene (19.1%) ✓
- D Letrozole superior only in obese women (BMI > 30)
Correct answer: C. Significantly higher with letrozole (27.5%) than clomiphene (19.1%)
Explanation
The LEGRO 2014 trial found that letrozole achieved a significantly higher cumulative live birth rate (27.5%) compared to clomiphene citrate (19.1%) in women with PCOS-related infertility (P = 0.007). Letrozole also had fewer multiple pregnancies. This landmark trial established letrozole as the preferred first-line ovulation induction agent in PCOS, replacing clomiphene as the drug of choice per many guidelines.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
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