Scholarlink

<p>Polycystic ovarian syndrome (PCOS) is a leading cause of infertility due to chronic anovulation. Letrozole is the first-line treatment for ovulation induction, but combination therapy with clomiphene citrate (CC) may enhance outcomes. We conducted a systematic search of three databases until October 2024, including randomized controlled trials (RCTs). Bias was assessed using the Revised Cochrane risk of bias tool (RoB 2). Six RCTs with 619 PCOS patients were included. The combination of Letrozole and CC resulted in a higher, though non-significant, ovulation rate (53.74%) vs. Letrozole alone (40.08%) (OR 1.22, 95% CI [0.88, 1.69], <i>P</i> = 0.23). Lower-dose combination therapy (50&#xa0;mg CC + 2.5&#xa0;mg Letrozole) significantly improved ovulation (OR 4.45, 95% CI [2.19, 9.08], <i>P</i> &lt; 0.001), whereas higher-dose therapy (100&#xa0;mg CC + 5&#xa0;mg Letrozole) had no effect. Pregnancy rates were higher with combination therapy (26.25% vs. 22.18%) but not significant (OR 1.26, 95% CI [0.84–1.88], <i>P</i> = 0.26). Miscarriage rates were lower (OR 0.32, 95% CI [0.12–0.88], <i>P</i> = 0.03). Lower-dose combination therapy also increased the proportion of follicles &gt; 15&#xa0;mm (OR 4.09, 95% CI [1.94, 8.60], <i>P</i> &lt; 0.001), with no significant differences in endometrial thickness, follicular size, or progesterone levels. Side effects were similar, though hot flushes were more common with combination therapy (OR 2.99, 95% CI [1.23, 7.23], <i>P</i> = 0.02). Our results support lower-dose combination therapy for improved ovulation, follicle count, and pregnancy outcomes while reducing miscarriage risk.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Combined Letrozole and Clomiphene Citrate Versus Letrozole Alone in Ovulation Induction for Polycystic Ovarian Syndrome Patients: A Systematic Review and Meta-analysis of Randomized Controlled Trials

  • 期刊论文

  • 发表日期：

    2025年10月21日

查看全文
  • Zainah Abdulbari Alhebshi,
  • Dalia Hamed Alqarni,
  • Albaraa A. Najjar,
  • Seham Shafi Alshalahi,
  • Rama A. Alhatlani,
  • Ayesha Jamal,
  • Hanan Muhammed Ismail Wasaya,
  • Mariah Almehmadi,
  • Maria Abdulaziz Alrafi,
  • Nadiah AlHabardi

摘要

Polycystic ovarian syndrome (PCOS) is a leading cause of infertility due to chronic anovulation. Letrozole is the first-line treatment for ovulation induction, but combination therapy with clomiphene citrate (CC) may enhance outcomes. We conducted a systematic search of three databases until October 2024, including randomized controlled trials (RCTs). Bias was assessed using the Revised Cochrane risk of bias tool (RoB 2). Six RCTs with 619 PCOS patients were included. The combination of Letrozole and CC resulted in a higher, though non-significant, ovulation rate (53.74%) vs. Letrozole alone (40.08%) (OR 1.22, 95% CI [0.88, 1.69], P = 0.23). Lower-dose combination therapy (50 mg CC + 2.5 mg Letrozole) significantly improved ovulation (OR 4.45, 95% CI [2.19, 9.08], P < 0.001), whereas higher-dose therapy (100 mg CC + 5 mg Letrozole) had no effect. Pregnancy rates were higher with combination therapy (26.25% vs. 22.18%) but not significant (OR 1.26, 95% CI [0.84–1.88], P = 0.26). Miscarriage rates were lower (OR 0.32, 95% CI [0.12–0.88], P = 0.03). Lower-dose combination therapy also increased the proportion of follicles > 15 mm (OR 4.09, 95% CI [1.94, 8.60], P < 0.001), with no significant differences in endometrial thickness, follicular size, or progesterone levels. Side effects were similar, though hot flushes were more common with combination therapy (OR 2.99, 95% CI [1.23, 7.23], P = 0.02). Our results support lower-dose combination therapy for improved ovulation, follicle count, and pregnancy outcomes while reducing miscarriage risk.