Aromatase inhibitors (letrozole) for ovulation induction in infertile women with polycystic ovary syndrome

Franik, Sebastian; Le, Quang-Khoi; Kremer, J.A.M.; Kiesel, L.; Farquhar, Cindy

doi:10.1002/14651858.cd010287.pub4

Cited by 14 publications

(8 citation statements)

References 93 publications

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“…The D5 group resulted in an increased pregnancy rate compared to the D3 group (RR 1.158, 95% CI 1.007 to 1.331). Our pregnancy rate was higher than that of the most recent Cochrane review (35%) (21), and we had obese patients lose weight before our OI treatment may have contributed to this. Moreover, our small sample size could be a contributing factor.…”

Section: Discussioncontrasting

confidence: 67%

Effect of different timing of letrozole initiation on pregnancy outcome in polycystic ovary syndrome

Shi

Ye²,

Gao³

et al. 2022

Front. Endocrinol.

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ObjectiveTo investigate the efficacy of oral letrozole (LE) starting on day 3 or 5 of the menstrual cycle in patients with polycystic ovary syndrome (PCOS).DesignRetrospective cohort study.SettingReproductive Endocrinology Department of Hangzhou Women’s Hospital.MethodsIn this retrospective analysis, we analyzed patients who received oral LE for ovulation induction (OI) at the Hangzhou Women’s Hospital from January 2016 to January 2021. In total, 539 PCOS patients with fertility requirements were classified into the D3 group and D5 group according to the different starting times of oral LE, that is, from the 3rd or 5th day of the menstrual cycle or LE is taken orally for 5 days starting on day 3 or 5 of progesterone withdrawal bleeding. Treatment started with one tablet (LE 2.5 mg), continue the regimen from the previous cycle in non-responders and continued until pregnancy or for up to three ovulatory cycles, with visits to determine ovulation and pregnancy, followed by tracking of pregnancies. The primary outcome was to compare ovulation rates, conception rates, live birth rates, pregnancy complications, and pregnancy outcomes at different initiation times.ResultsWomen who started LE on the 5th day of their menstrual cycle had more cumulative conception rates than those who started LE on the 3rd day(173 of 228[75.9%]vs. 201 of 311[64.6%], P= 0.005; rate ratio for conception, 1.174; 95% confidence interval,1.052 to 1.311) without significant differences in overall live birth rate, though there were 142 of 228[62.3%] in the D5 group versus 172 of 311[55.3%] in the D3 group (P= 0.105). The median (IQR) endometrial thickness was significantly (P = 0.013) greater during the D5 group treatment compared to the D3 group, which may be related to higher conception and clinical pregnancy rates. The median (IQR) maximum follicle diameter was not statistically (P = 0.073) different between the two groups. The cumulative ovulation per cycle rate was higher with D5 than with D3 (287 of 405 treatment cycles [70.9%] vs. 388 of 640 treatment cycles [60.6%], P=0.001). There were no significant between-group differences in pregnancy loss (31 of 173 conceptions in the D5 group [17.9%] and 29 of 201 conceptions in the D3 group [14.4%]) or multiples pregnancy (8.2% and 10.5%, respectively). Rates of other adverse events during pregnancy were similar in the two treatment groups.ConclusionAs compared with D3 group, D5 group was associated with higher ovulation and conception rates, shorter time-to-pregnancy among infertile women with the PCOS.

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Section: Discussioncontrasting

confidence: 67%

Effect of different timing of letrozole initiation on pregnancy outcome in polycystic ovary syndrome

Shi

Ye²,

Gao³

et al. 2022

Front. Endocrinol.

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“…Compared to clomiphene citrate, letrozole significantly improves ovulation and live birth rates. 16 Clomiphene citrate is no longer available in Canada.…”

Section: Infertilitymentioning

confidence: 99%

Management of Polycystic Ovarian Syndrome: Looking Beyond the Ovaries

Yap-Garcia

2024

Can Womens Health Today

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There is something remiss in the name polycystic ovarian syndrome (PCOS). It bears the word ovary; however, the ovary is an innocent bystander of a more sinister pathology. The name belies the nature of a disease that is a complex metabolic and reproductive syndrome with sequelae extending beyond ovarian dysfunction. PCOS is a chronic, life-long illness that affects approximately 1.4 million Canadians. Its inception is thought to begin in utero. Factors such as elevated levels of maternal anti‑Müllerian hormone (AMH), endocrine disruptors, growth restriction, and maternal androgen excess generate epigenetic changes that have a life-long, transgenerational impact on the fetus.

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“…20 Letrozole appears to improve live birth rates and pregnancy rates in infertile women with anovulatory PCOS, compared to selective oestrogen receptor modulator (SERMs), when used for ovulation induction, followed by intercourse. 21 The study was of low scientific quality and has never been published in its entirety in a journal subject to peer review. Subsequent investigations on the use of letrozole for ovulation induction have not demonstrated an increased risk of malformations, despite the fact that none of them have statistical significance.…”

Section: Figure 2 Comparison Of Ovulation and Labor Rates Of Patients...mentioning

confidence: 99%

Letrozole Compared With Clompihene Citrate for Polycystic Ovarian Syndrome : a Systematic Review

Alicia

2023

JARMHS

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According to the Consensus on the Management of PCOS, polycystic ovary syndrome, is an endocrine condition that produces oligo-anovulation, clinical and biochemical symptoms of hyperandrogenism, and distinctive ovarian morphological characteristics on ultrasonographic examination. PCOS is also associated with a higher risk of endometrial cancer. Both hyperandrogenism and anovulation are difficult conditions to manage. PCOS women often have higher GnRH pulsatility, which in turn causes increased pituitary LH secretion and an elevated LH/FSH ratio. Granulosa cells are responsible for the conversion of androgens to estrogen and the maturation of follicles, while LH is responsible for promoting androgen synthesis in theca cells. Intraovarian androgens produce atresia in later antral stages, although they do boost initial follicle recruitment by increasing preantral and early antral follicle growth. In contrast to CC on its own, letrozole was shown to increase the number of live births, and the overall level of evidence was moderate. There was insufficient evidence that there was a difference in the rate of live births between CC plus metformin and CC alone, and the overall certainty of the evidence was poor due to the risk of bias and imprecision. When contrasted with the use of CC by itself, the potential benefit of CC in combination with metformin was more apparent in women whose baseline blood insulin or HOMA-IR values were higher than average. In comparison to clomiphene citrate, letrozole was related with higher rates of ovulation, pregnancy, and successful delivery of a live baby. Despite the fact that the quality of the data is inconsistent, one study recommends letrozole over clomiphene citrate as an ovulation induction medicine for women who have infertility and PCOS.

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Aromatase inhibitors (letrozole) for ovulation induction in infertile women with polycystic ovary syndrome

Cited by 14 publications

References 93 publications

Effect of different timing of letrozole initiation on pregnancy outcome in polycystic ovary syndrome

Effect of different timing of letrozole initiation on pregnancy outcome in polycystic ovary syndrome

Management of Polycystic Ovarian Syndrome: Looking Beyond the Ovaries

Letrozole Compared With Clompihene Citrate for Polycystic Ovarian Syndrome : a Systematic Review

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