Breast cancer medication letrozole could increase ovulation in women with PCOS

A medicine used in breast cancer treatment is now considered the best option for treating the most common cause of infertility.

Letrozole has been found to increase ovulation in women with Polycystic Ovarian Syndrome (PCOS), a common form of ovulation dysfunction, leading to a 40 percent increase in pregnancy rates and more ovulation and live births than Clomid, the previous standard.

In breast cancer patients, Letrozole decreases the amount of estrogen, but a side effect is increased ovulation.

"We have found out that the hormonal messages affect different areas of the body in different ways," said Dr. Stephanie Estes, a board certified fertility specialist and director of the Robotic Surgery Program at Penn State Health Milton S. Hershey Medical Center.

She suggests that patients whose infertility is caused by irregular ovulation ask their providers about letrozole, since news of its effectiveness as an infertility treatment hasn't spread very quickly. "It is easy to take, has a low rate of multiple births, and fewer side effects than Clomid," Estes said.

If infertility is caused by male factors or simply unexplainable, doctors may recommend other medicines, injectables, inseminations or in-vitro fertilization (IVF), depending on the diagnosis.

"You always have to look at the underlying cause to pick which treatment is correct," Estes said.

Intra-uterine insemination (IUI) places concentrated sperm directly into the woman's uterus so it doesn't have so far to travel and thus increases chances of fertilization. With IVF, the woman's eggs are harvested and combined with sperm in an embryology laboratory and then an embryo is placed into the uterus.

"IVF is becoming more and more successful, so its availability to patients has improved," Estes said. "More states and companies are seeing the importance of family-building within the job, so now there is a lot more coverage for these treatments."

Estes said most insurance companies will cover fertility testing, even if they don't cover the treatments. "Many people just wait and hope, and their family tells them it will happen when it is supposed to happen," Estes said. "But why not come and see what the issue might be?"

She recommends that fertility evaluations be done by a reproductive endocrinologist, and that couples get evaluated if they are 35 or older with regular menstrual cycles and have been trying to get pregnant for more than six months. If they are under 35 and have been trying to get pregnant for 12 months, it might be time to make an appointment. Women should be seen sooner if they do not have regular menses, have a history of chemotherapy or radiation treatment or if there is a known male factor.

Estes said it's hard to tell whether more couples are struggling with infertility these days or if it is just more common to hear about because of improved technology and successful treatment options: "More people are coming forward because there is more knowledge and availability, but we also have more to offer with success, so that creates a cycle."

Newer minimally invasive surgical procedures can treat endometriosis, help doctors evaluate fallopian tubes and remove large fibroids that may affect fertility.

Then there are complimentary, holistic treatments such as acupuncture, which Estes says have conflicting results as far as how much they help with fertility. "We can't say they will solve the issues, but we don't know of harmful effects from them, so if it decreases a woman's stress, then do it."

One of the most common things many couples don't think about is to make sure they have a clean bill of health and live the most healthy lifestyle they can before trying to get pregnant.

"Things like smoking cessation and limiting caffeine and alcohol use, as well as the appropriate timing of intercourse can all help maximize your chances," Estes said.