The TOGGLE trial evaluated letrozole versus clomiphene as first-line ovulation induction in PCOS. Which is the MOST accurate conclusion from this evidence?
- A Clomiphene is superior to letrozole in terms of live birth rate
- B Both agents have equivalent live birth rates but letrozole has fewer side effects
- C Letrozole results in higher cumulative live birth rates than clomiphene in clomiphene-naive PCOS women ✓
- D Letrozole is superior only in obese PCOS women (BMI > 30)
Correct answer: C. Letrozole results in higher cumulative live birth rates than clomiphene in clomiphene-naive PCOS women
Explanation
The landmark Legro et al. NEJM 2014 trial (often referenced alongside TOGGLE) demonstrated that letrozole achieves significantly higher cumulative ovulation, pregnancy, and live birth rates compared to clomiphene in PCOS women, with similar or fewer adverse outcomes. Letrozole's lack of anti-oestrogenic effect on the endometrium and cervical mucus explains its superior implantation rates. It is now recommended as first-line by WHO, NICE, and ESHRE/ASRM guidelines.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.