Effects of letrozole alone or in combination with gonadotropins on ovulation induction and clinical pregnancy in women with polycystic ovarian syndrome: a systematic review and meta-analysis of randomized controlled trials

Saeed Baradwan; Faisal Al-Shalhoub; Majed Saeed Alshahrani; Samah Himayda; Rayan AlSghan; Hussein Sabban; Inass Hassan Ahmad; Marwa Fekry Mohamed El Sayed; Entesar Omar Mohamad; Abdulhadi A AlAmodi; Ahmed Mohamed Abdelhakim; Kareem Shaheen

doi:10.1007/s42000-024-00531-4

Effects of letrozole alone or in combination with gonadotropins on ovulation induction and clinical pregnancy in women with polycystic ovarian syndrome: a systematic review and meta-analysis of randomized controlled trials

Hormones (Athens). 2024 Jan 27. doi: 10.1007/s42000-024-00531-4. Online ahead of print.

Affiliations

¹ Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia.
² Department of Obstetrics and Gynecology, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia.
³ Department of Obstetrics and Gynecology, Faculty of Medicine, Najran University, Najran, Saudi Arabia.
⁴ Department of Obstetrics and Gynecology, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia.
⁵ Department of Obstetrics and Gynecology, Maternity and Children Hospital, Al-Kharj, Saudi Arabia.
⁶ Department of Obstetrics and Gynecology, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah, Saudi Arabia.
⁷ Department of Endocrinology and Metabolism, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt.
⁸ College of Health Sciences and Public Health, Jackson State University, Jackson, MS, USA.
⁹ Kasralainy Faculty of Medicine, Cairo University, 395 Portsaid Street, Bab El-Kalq, Cairo, 11638, Egypt. ahmed.m.rohei@students.kasralainy.edu.eg.
¹⁰ Department of Obstetrics and Gynecology, Faculty of Medicine, Minia University, Minia, Egypt.

PMID: 38280115
DOI: 10.1007/s42000-024-00531-4

Abstract

Objective: To compare letrozole in combination with gonadotropins versus letrozole monotherapy in ovulation induction and clinical pregnancy among infertile women with polycystic ovarian syndrome (PCOS).

Methods: Several databases were searched for available clinical trials from inception until March 2023. We selected randomized controlled trials (RCTs) that compared sequential letrozole/gonadotropin versus letrozole alone among infertile women who met the Rotterdam criteria for PCOS. RevMan software was used to perform our meta-analysis. Our primary outcomes were ovulation and clinical pregnancy rates. Our secondary outcomes were endometrial thickness, number of mature follicles (diameter ≥ 18 mm), and incidence of miscarriage and ovarian hyperstimulation syndrome (OHSS).

Results: Six RCTs were retrieved with a total number of 723 patients. The ovulation and clinical pregnancy rates were significantly higher among the letrozole/gonadotropin group versus the letrozole monotherapy group (p < 0.001). In addition, there were significant improvements in endometrial thickness and number of mature follicles in the letrozole/gonadotropin group. There were no significant differences between the two groups regarding incidence of miscarriage and ovarian hyperstimulation syndrome.

Conclusion: Letrozole in combination with gonadotropin is superior to letrozole alone in improving ovulation induction and clinical pregnancy among PCOS patients. More trials are required to confirm our findings.

Keywords: Gonadotropins; Letrozole; PCOS; Polycystic ovary syndrome; Pregnancy rate.

Publication types

Review