Comparison of clomiphene citrate and letrozole for ovulation induction in women with polycystic ovary syndrome: a prospective randomized trial

Abstract

To compare the therapeutic efficacy of clomiphene citrate (CC) and letrozole (LE) on ovulation, pregnancy, and live birth in women with polycystic ovary syndrome (PCOS); and to ensure if LE can replace CC as the first-line therapy for ovulation induction in these women. This is a prospectively, randomized, controlled trial in the tertiary hospital. Two-hundred and sixty-eight anovulatory PCOS patients were treated by CC or CC plus metformin and LE or LE plus metformin for three continuous cycles or conception; their ovulation rates, pregnancy rates, and live birth rates were calculated and compared. No significant difference was noted among the four groups regarding to the baseline data of clinical manifestations, serum sex hormone levels, and serum insulin levels. A total of 240 patients completed the therapies. The ovulation rate was significantly higher in the group LE than the group CC; however, no significant difference was noted between the groups LE and CC, CC, and CC + MET, or LE and LE + MET in the pregnancy rate, abortion rate, and live birth rate. No birth defect was found in the total of 63 newborns. CC regimen was still recommended to be the first-line therapy of ovulation induction for PCOS.

Letrozole is superior to clomiphene citrate in ovulation induction in patients with polycystic ovary syndrome

“…The abortion rate is higher in PCOS patients than in the normal population 23 Disorders such as endometrial receptivity, corpus deficiency, impaired quality of ovum, hyperandrogenism, and insulin resistance are among the causes of abortion in patients with PCOS. 14 Abortion rates were similar in the majority of studies comparing CC and LTZ. 20 Following the literature, in our study, abortion rates were similar in both groups (p=0.804).…”

“…Oral preparations are used as the first-line treatment in ovulation induction of patients with PCOS. 14 Although CC has been used for a long time in treating patients with PCOS, the adverse effects it causes have led clinicians to seek different treatment modalities. For this purpose, LTZ is widely used, but the results are contradictory in studies comparing the success of CC and LTZ treatment in patients with PCOS.…”

“…However, there was no statistically significant difference between pregnancy rates and live birth rates with LTZ and CC. 14 Therefore, they suggested that CC remains the first-line OI agent in PCOS patients. In this study, the clinical pregnancy rate was 33.1%, and the live birth rate was 29.1% in the LTZ group.…”

Letrozole versus clomiphene citrate for ovulation induction in anovulatory women with polycystic ovarian syndrome: A randomized controlled trial

“…This has a favorable effect on the endometrium and hence on pregnancy rates 8 . Various clinical trials have compared the efficacy of letrozole and CC in infertile women with PCOS 3,4,9–13 . These studies have also been analyzed in a Cochrane systematic review and a recent individual patient data meta‐analysis 14,15 .…”

Comparação da eficácia dos medicamentos para indução de ovulação em mulheres com Síndrome do Ovário Policístico resistentes ao citrato de clomifeno

“…Os resultados mostraram aumento na taxa + metformina (p<0,001). Quando comparados, os grupos que utilizaram letrozol, de forma isolada ou combinada, as taxas de ovulação e de gravidez foram maiores com letrozol + metformina, mas sem diferenças significativas (p>0,05)(LIU C, et al, 2017). Uma meta-análise de 2017, demonstrou que a terapia com CC + metformina foi significativamente menos eficaz que a terapia com letrozol + metformina em relação a taxa de nascidos vivos (p=0,04).…”