Letrozole versus clomiphene citrate in polycystic ovary syndrome: a meta-analysis of randomized controlled trials
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Polycystic ovary syndrome (PCOS) is a common endocrine disturbance affecting women in the reproductive age group. The present study aimed to compare the effects of letrozole (LE) and clomiphene citrate (CC) for ovulation induction in women with PCOS.
The PUBMED, Web of Science, and EMBASE databases were screened systematically for randomized controlled trials (RCTs) published from database inception to July 2017.
Eleven RCTs involving 2255 patients were included, and data were independently extracted and analyzed using 95% risk ratios (RRs) and confidence intervals (CIs) based on a random- or fixed-effect model (as appropriate). Meta-analyses of nine RCTs comparing LE and CC ovulation induction, followed by timed intercourse, indicated that the former significantly increased the ovulation rate (RR = 1.18; 95% CI 1.03–1.36, P = 0.01), pregnancy rate (RR = 1.34; 95% CI 1.09–1.64, P = 0.006), and live birth rate (RR = 1.55; 95% CI 1.28–1.88, P < 0.00001). However, LE and CC did not differ significantly in terms of the multiple pregnancy and abortion rates. Furthermore, LE for ovulation induction significantly improved the pregnancy rate after IUI.
LE is superior to CC for ovulation induction in patients with PCOS.
KeywordsLetrozole Clomiphene citrate Polycystic ovary syndrome Randomized controlled trials Meta-analysis
This work was supported by the National Natural Science Foundation of China (Grant no. 81671507), Fundamental Research Funds for the Central Universities (HUST; Grant no. 2015ZDTD050), and National Key Research and Development Program (Grant no. 2016YFC1000903).
SH, first author: project development, data collection, data analysis, and manuscript writing. QY, co-first author: project development, data collection, statistical analysis. YW and MW: data collection. WX, corresponding author: manuscript editing. CZ, co-corresponding author: manuscript editing.
Compliance with ethical standards
Conflict of interest
The authors declare no conflicts of interest.
- 2.Nestler JE (2016) Polycystic ovary syndrome. N Engl J Med 375:1398. https://doi.org/10.1056/NEJMc1610000.10.1056/NEJMc1610000#SA2 PubMedGoogle Scholar
- 3.Fauser BC, Tarlatzis BC, Rebar RW, Legro RS, Balen AH, Lobo R, Carmina E, Chang J, Yildiz BO, Laven JS, Boivin J, Petraglia F, Wijeyeratne CN, Norman RJ, Dunaif A, Franks S, Wild RA, Dumesic D, Barnhart K (2012) Consensus on women’s health aspects of polycystic ovary syndrome (PCOS): the Amsterdam ESHRE/ASRM-Sponsored 3rd PCOS Consensus Workshop Group. Fertil Steril 97(28–38):e25. https://doi.org/10.1016/j.fertnstert.2011.09.024 Google Scholar
- 15.Roy KK, Baruah J, Singla S, Sharma JB, Singh N, Jain SK, Goyal M (2012) A prospective randomized trial comparing the efficacy of letrozole and clomiphene citrate in induction of ovulation in polycystic ovarian syndrome. J Hum Reprod Sci 5:20–25. https://doi.org/10.4103/0974-1208.97789 CrossRefPubMedPubMedCentralGoogle Scholar
- 18.Ganesh A, Goswami SK, Chattopadhyay R, Chaudhury K, Chakravarty B (2009) Comparison of letrozole with continuous gonadotropins and clomiphene-gonadotropin combination for ovulation induction in 1387 PCOS women after clomiphene citrate failure: a randomized prospective clinical trial. J Assist Reprod Genet 26:19–24. https://doi.org/10.1007/s10815-008-9284-4 CrossRefPubMedPubMedCentralGoogle Scholar
- 22.Legro RS, Brzyski RG, Diamond MP, Coutifaris C, Schlaff WD, Casson P, Christman GM, Huang H, Yan Q, Alvero R, Haisenleder DJ, Barnhart KT, Bates GW, Usadi R, Lucidi S, Baker V, Trussell JC, Krawetz SA, Snyder P, Ohl D, Santoro N, Eisenberg E, Zhang H (2014) Letrozole versus clomiphene for infertility in the polycystic ovary syndrome. N Engl J Med 371:119–129. https://doi.org/10.1056/NEJMoa1313517 CrossRefPubMedPubMedCentralGoogle Scholar
- 27.Dehbashi S, Dehbashi S, Kazerooni T, Robati M, Alborzi S, Parsanezhad ME, Shadman A (2009) Comparison of the effects of letrozole and clomiphene citrate on ovulation and pregnancy rate in patients with polycystic ovary syndrome. Iran J Med Sci 34:23–28Google Scholar