The PPCOSII (Pregnancy in Polycystic Ovary Syndrome II) trial compared letrozole versus clomiphene citrate for ovulation induction. Its key finding was:
- A Clomiphene had higher live birth rates due to better ovulation rates
- B Both drugs had equal live birth rates but letrozole had fewer multiple gestations
- C Letrozole had significantly higher live birth rates and ovulation rates than clomiphene ✓
- D Letrozole was only superior in obese PCOS women
Correct answer: C. Letrozole had significantly higher live birth rates and ovulation rates than clomiphene
Explanation
The landmark PPCOSII trial (NEJM 2014, Legro et al.) demonstrated that letrozole (aromatase inhibitor) was superior to clomiphene citrate for ovulation induction in PCOS, with higher cumulative live birth rates (27.5% vs 19.1%) and ovulation rates. Letrozole avoids the anti-oestrogenic effect on endometrium seen with clomiphene. This trial established letrozole as the preferred first-line drug for ovulation induction in PCOS.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
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