LETROZOLE PROTOCOLS IN OVULATION INDUCTION

ONE PAGE CALENDAR-2020 JUNE DATES

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For Successful Ovula on Induc on MAR NOV Letrozole 2.5 mg. Tablets

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1st line therapy in unexplained infertility

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Letrozole in combination with gonadotrophins Lowers the dosage of gonadotrophins

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Lowers the cost of IUI/IVF cycles

Letrozole 5 mg. Tablets

Ideal choice in CC resistant cases, obese PCOS & poor responders

High Dose offers More mature follicles & higher ovulation rate 4.5 times higher pregnancy rate compared to Letrozole 2.5 mg

From The Makers of

From The Makers of

Letrozole 5 mg. / 2.5 mg. Tablets

Letrozole 5 mg. / 2.5 mg. Tablets

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S mula on with letrozole

Conference Calendar

The recommended 1st line treatment option in OI Protocol 1

Protocol 2

Protocol 3

Standard Protocol

Superovulation Protocol

Extended Protocol

December 2020

Protocol 4

Protocol 5

Protocol 6

Step-up Protocol

Single Dose (20 Mg) Protocol

High Dose Protocol

Protocol 7

Protocol 8

Protocol 9

Letrozole + GnRH Agonist Protocol

Letrozole + GnRH Antagonist Multiple Dose Protocol

Minimum Dose Stimulation (MS) Protocol

Protocol 10

Protocol 11

High Dose Stimulation Protocol

Sequential Letrozole & HMG Protocol

FOGSI- ICOG National Conference Date: 4-6 December 2020

From The Makers of

From The Makers of

Letrozole 5 mg. / 2.5 mg. Tablets

Letrozole 5 mg. / 2.5 mg. Tablets

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Place: Mumbai,Maharashtra

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S mula on with letrozole

Conference Calendar

Standrad Protocol PCOS & CC Resistant PCOS

November 2020

Compared with Clomiphene, is associated with…

(Letrozole)

•Higher ovulation rate

•Higher live birth rate

•Higher pregnancy rate

•Monofollicular ovulation

FOGSI-SAFOG-FIGO Conference Date: 27-29 November 2019

Place: Bengaluru,karnataka

(Letrozole) 2.5 mg / day from day 3 - 7

Days 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Reference: Legro RS, Brzyski RG, Diamond MP, Coutifaris C, Schlaff WD, et al. Letrozole versus Clomiphene for Infertility in the Polycystic Ovary Syndrome.

N Engl J Med. 2014;371(2) 119–129

From The Makers of

From The Makers of

Letrozole 5 mg. / 2.5 mg. Tablets

Letrozole 5 mg. / 2.5 mg. Tablets

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Conference Calendar

Superovulation Protocol For IUI Idiopathic Infertility

October 2020

Superovulation Protocol with is associated with…

•Higher pregnancy rate

(Letrozole) 5 mg eema HP hCG 10000 IU If at least 1 follicle attained > 18

•Higher number of mature follicles

IFCPC INDIA 2020 Date: 1-4 october 2020

Place: Hyderabad,Telangana

EMA Annual Conference with FOGSI Date: 9-11 October 2020 Place: Dubai

•Better endometrial thickness IUI performed 24 and 48 Hours later

(Letrozole) 5 mg / day from day 3 - 7

Yuva FOGSI 2020 - East Zone Date: 16-18 October 2020 Place: Siliguri,West Bengal

Days 1 2 3 4 5 6 7 8 9 10 11 12 13 14

Conquering Infection in Obs-Gyn Date: 30 October 2020 - 1 November 2020 Place: Jaipur

Reference:Al-Fadhli, Sylvestre C, Buckett W, Tan SL, Tulandi T, et al. A randomized trial of superovulation with two different doses of letrozole.

Fertil Steril. 2006;85(1):161-4.

From The Makers of

From The Makers of

Letrozole 5 mg. / 2.5 mg. Tablets

Letrozole 5 mg. / 2.5 mg. Tablets

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S mula on with letrozole

Conference Calendar

Extended Protocol PCOS & CC Resistant PCOS

September 2020

The long (Letrozole) protocol (10 days) is associated with…

•Higher ovulation & pregnancy rate •Multifollicular ovulation •Higher number of mature follicles

Yuva FOGSI 2020 - West Zone Date: 4-6 September 2020

Place: Daman

eema HP hCG 5000 IU

If at least 1 follicle attained > 18

•Higher endometrial thickness Intercourse after 24-36 hrs

(Letrozole) 2.5 mg / day from day 1 - 10

Webcast Conference on PCOS: Managing the Eternal Challenge Date: 25 September 2020

Days

1 2 3 4 5 6 7 8 9 10 11 12 13 14 Reference: Badawy A, Mosbah A, Tharwat A, Eid M. Fertil Steril. 2009;92(1):236–239

From The Makers of

From The Makers of

Letrozole 5 mg. / 2.5 mg. Tablets

Letrozole 5 mg. / 2.5 mg. Tablets

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S mula on with letrozole

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Step-up Protocol PCOS & CC Resistant PCOS

August 2020

The step-up is associated with…

(Letrozole) protocol

•Multifollicular development •Higher clinical pregnancy rate

eema HP hCG 5000 IU If at least 1 follicle attained > 20 mm

•Better endometrial thickness

5 mg

7.5 mg

Place: Sydeny

International Adolescent Health Conference Date: 28-30 Aug 2020 Place: New Delhi

Insemination done 24 hrs later

(Letrozole) 2.5 mg

FOGSI Conference at Australia Date: 15-16 August 2020

10 mg

Days 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Reference: Mitwally MF, Said T, Galal A, Chan S, Cohen M, et al.Fertil Steril. 2008;89(4):S23-S24.

From The Makers of

From The Makers of

Letrozole 5 mg. / 2.5 mg. Tablets

Letrozole 5 mg. / 2.5 mg. Tablets

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Single Dose (20 mg) Protocol Unexplained Infertility

July 2020

Single dose is associated with…

(Letrozole) protocol

•Higher ovulation & pregnancy rate

•Lower serum E2 level on day of hCG administration

•Better endometrial thickness •Lower FSH dose required

eema HP hCG 10000 IU If at least 1 follicle attained > 18

(Letrozole)

Single dose of 20 mg on day 3 eema FSH 50-150 IU/day start from day 7 till the day of hCG administration

Intercourse or Insemination

Funference - FOGSI Friends Conclave 2020 Date: 18-19 July 2020 Place: Goa FOGSI POGS 2020 Date: 24-26 July 2020

Place: Pune,Maharashtra

Days 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Reference : Mitwally MFM, Casper RF.Fertil Steril. 2005; 83:229 –31

From The Makers of

From The Makers of

Letrozole 5 mg. / 2.5 mg. Tablets

Letrozole 5 mg. / 2.5 mg. Tablets

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High Dose (7.5 Mg) Protocol Anovulatory Infertility

June 2020

Compared with clomiphene, is associated with…

(Letrozole)

•Higher ovulation rate

Gestosis 2020 Date: 12-14 June 2020

•Higher pregnancy rate

Place: Patna,Bihar

•Higher endometrial thickness •Lower serum E2 level on day of hCG administration (Letrozole)

7.5 mg / day from day 3 - 7

eema HP hCG 10000 IU

If at least 1 follicle attained > 18 mm

7th International Congress on Critical Care in Obstetrics Date: 26-28 June 2020 Place: Ahmedabad, Gujarat

Days 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Reference : Begum MR, Ferdous J, Begum A, Quadir E. Fertil

Steril. 2009;92:853–7

From The Makers of

From The Makers of

Letrozole 5 mg. / 2.5 mg. Tablets

Letrozole 5 mg. / 2.5 mg. Tablets

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Letrozole + GnRH Agonist Protocol

May 2020

Endometriosis (Letrozole) + GnRH agonist protocol is associated with…

•Increased days of stimulation •Lower PG E production •Lower estrogen level GnRH agonist started at mid luteal phase

Stimulet 5 (Letrozole) 5 mg/day for 10 days, 5 days after GnRH agonist

eema HP hCG 10000 IU

Most of the follicles 18-20 mm Serum E2= 150-200 pg/ml for follicles >15 mm Endometrial thickness >9 mm

Love to Labour Conclave by OGSSI - South Zone Date: 29-31 May 2020 Place: Chennai,Tamilnadu

Days 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Reference : Rabbo MSA, Elmaghraby HA, Mashali NA, Moneim MEA. Alexandria Journal of Medicine. 2012;48(4):303-307.

From The Makers of

From The Makers of

Letrozole 5 mg. / 2.5 mg. Tablets

Letrozole 5 mg. / 2.5 mg. Tablets

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Letrozole + GnRH Antagonist Multiple Dose Protocol Poor Responders To COS/IVF

April 2020

(Letrozole)+GnRH agonist multiple dose protocol is associated with…

•Shorter duration of rFSH administration •Reduced dose of rFSH •Increased ovarian stimulation to gonadotropins •Increased oocyte retrieval rate (Letrozole)

2.5mg/day from day 3-7

rFSH 225 IU from stimulation day 3

hCG 250 µg + GnRH agonist 0.1 mg

GnRH antagonist 0.025 mg/day

1 or more follicles ≥18 mm

Lead follicle 13-14 mm

Insemination after 36 hrs

Yuva FOGSI 2020 - North Zone Date: 17 - 19 April 2020

Place: Zirakpur,Punjab

Days 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Reference : Lee KH, Kim CH, Suk HJ, Lee YJ, KwonSK, et al. Obstet Gynecol Sci. 2014;57(3):216–222

From The Makers of

From The Makers of

Letrozole 5 mg. / 2.5 mg. Tablets

Letrozole 5 mg. / 2.5 mg. Tablets

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S mula on with letrozole

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Minimum Dose Stimulation (MS) Protocol Poor Ovarian Reserve

March 2020

MS protocol is associated with…

•Low gonadotropin dosage •Reduced cost

eema HP hCG 10000 IU

•Improved clinical pregnancy rates •Improved live birth rates (Letrozole)

2.5mg/day from day 2-6

Low dose eema HMG 150 iu/day on day 4

GnRH antagonist 0.025 mg/day

2 or more follicles ≥18 mm

1 or more follicles 14 mm

ICSI after 36 hrs

Days 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Reference : Lazer T, Dar S, Shlush E, Al Kudmani BS, Quach K, et al. Int J Reprod Med. 2014;2014:581451

From The Makers of

From The Makers of

Letrozole 5 mg. / 2.5 mg. Tablets

Letrozole 5 mg. / 2.5 mg. Tablets

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High Dose Stimulation Protocol Oligoanovulation / Chronic Anovulation

February 2020

High dose protocol is associated with…

•Enhanced follicular growth •Higher ovulation rates •More mature follicle

•No detrimental effects on endometrium Medroxyprogesterone

(Letrozole)

12.5mg/day from day 3-7

If anovulatory

Days 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Reference Pritts EA, Yuen AK, Sharma S, Genisot R, Olive DL.

Surakshit Naritva - National FOGSI Conference Date: 29th February-1st March 2020 Place: New Delhi

ISRN Obstetrics and Gynecology2011;2011:242864.

From The Makers of

From The Makers of

Letrozole 5 mg. / 2.5 mg. Tablets

Letrozole 5 mg. / 2.5 mg. Tablets

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S mula on with letrozole

Conference Calendar January 2020

Sequential Letrozole & HMG Protocol PCOS

Sequential Letrozole & HMG Protocol is associated with…

•Enhanced follicular growth

•Higher ovulation rates

•More mature follicle

•No detrimental effects on endometrium

(Letrozole)

10 mg/day from day 2-6

eema HMG Ampoules 150-225 IU/day

From day 7 of menstrual flow till eema HP hCG administration

Days 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Reference :Galal AF, Fertil Steril. 2012;97(3):S4

From The Makers of

From The Makers of

Letrozole 5 mg. / 2.5 mg. Tablets

Letrozole 5 mg. / 2.5 mg. Tablets

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