A comparative study of the efficacy of letrozole versus clomiphene citrate for ovulation induction in anovulatory cycle in subfertile women
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20253898Keywords:
Anovulation, Clomiphene citrate, Letrozole, Ovulation inductionAbstract
Background: Anovulation is a leading cause of female infertility, with clomiphene citrate (CC) and letrozole (LTZ) being commonly used agents for ovulation induction. While CC has been the first-line therapy, its anti-estrogenic effects may impair endometrial receptivity. LTZ, an aromatase inhibitor, offers a potentially superior alternative by enhancing follicular sensitivity without adverse endometrial effects.
Methods: This randomized controlled trial was conducted at the department of obstetrics and gynecology, Government Medical College and Hospital, Akola, Maharashtra, involving subfertile women with anovulatory cycles. Participants were allocated to receive either CC or LTZ. Outcomes assessed included ovulation rate, pregnancy rate, cycles to conception, single follicle formation, and endometrial thickness. Data were analyzed using appropriate statistical methods.
Results: Letrozole demonstrated higher ovulation and pregnancy rates compared to clomiphene citrate. LTZ was associated with improved endometrial thickness and a greater proportion of monofollicular development. Fewer side effects and complications were observed in the LTZ group. The number of cycles required for conception was lower with LTZ.
Conclusions: Letrozole is more efficacious than clomiphene citrate for ovulation induction in anovulatory subfertile women. It offers better endometrial receptivity, higher pregnancy rates, and fewer adverse effects, making it a preferable first-line agent in selected cases.
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References
Mascarenhas MN, Flaxman SR, Boerma T, Vanderpoel S, Stevens GA. National, regional, and global trends in infertility prevalence since 1990: a systematic analysis of 277 health surveys. PLoS Med. 2012;9(12):e1001356. DOI: https://doi.org/10.1371/journal.pmed.1001356
Fritz MA, Speroff L. Clinical Gynecologic Endocrinology and Infertility. 8th ed. Philadelphia: Lippincott Williams & Wilkins; 2011.
World Health Organization. WHO Manual for the Standardized Investigation and Diagnosis of the Infertile Couple. Cambridge: Cambridge University Press; 2000.
Balen AH, Morley LC, Misso M, Franks S, Legro RS, Wijeyaratne CN, et al. The management of anovulatory infertility in women with polycystic ovary syndrome: an evidence-based guideline. Hum Reprod. 2016;31(12):2769-805.
Fauser BC, Tarlatzis BC, Rebar RW, Legro RS, Balen AH, Lobo R, et al. Consensus on women’s health aspects of polycystic ovary syndrome (PCOS): the Amsterdam ESHRE/ASRM-Sponsored 3rd PCOS Consensus Workshop Group. Fertil Steril. 2012;97(1):28-38.e25. DOI: https://doi.org/10.1016/j.fertnstert.2011.09.024
Homburg R. Clomiphene citrate- end of an era? A mini-review. Hum Reprod. 2005;20(8):2043-51. DOI: https://doi.org/10.1093/humrep/dei042
Dickey RP, Holtkamp DE. Development, pharmacology and clinical experience with clomiphene citrate. Hum Reprod Update. 1996;2(6):483-506. DOI: https://doi.org/10.1093/humupd/2.6.483
Brown J, Farquhar C, Beck J, Boothroyd C, Hughes E. Clomiphene and anti-estrogens for ovulation induction in polycystic ovarian syndrome. Cochrane Database Syst Rev. 2009;(4):CD002249. DOI: https://doi.org/10.1002/14651858.CD002249.pub4
Kousta E, White DM, Franks S. Modern use of clomiphene citrate in induction of ovulation. Hum Reprod Update. 1997;3(4):359-65. DOI: https://doi.org/10.1093/humupd/3.4.359
Mitwally MF, Casper RF. Aromatase inhibition: a novel method of ovulation induction in women with polycystic ovarian syndrome. Reprod Technol. 2000;10(4):244-7.
Holzer H, Casper RF, Tulandi T. A new era in ovulation induction. Fertil Steril. 2006;85(2):277-84. DOI: https://doi.org/10.1016/j.fertnstert.2005.05.078
Casper RF, Mitwally MF. Review: aromatase inhibitors for ovulation induction. J Clin Endocrinol Metab. 2006;91(3):760-71. DOI: https://doi.org/10.1210/jc.2005-1923
Badawy A, Mosbah A, Shady M, Tharwat A. Letrozole or clomiphene citrate for ovulation induction in women with polycystic ovarian syndrome: a prospective randomized trial. Fertil Steril. 2009;92(3):849-52. DOI: https://doi.org/10.1016/j.fertnstert.2007.02.062
Bayar U, Tanriverdi HA, Barut A, Ayoglu F, Ozcan O, Kaya E. Letrozole vs clomiphene citrate in patients with ovulatory infertility. Fertil Steril. 2006;85(4):1045-8. DOI: https://doi.org/10.1016/j.fertnstert.2005.09.045
Franik S, Kremer JA, Nelen WL, Farquhar C, Clark J. Aromatase inhibitors for subfertile women with polycystic ovary syndrome. Cochrane Database Syst Rev. 2018;5(5):CD010287. DOI: https://doi.org/10.1002/14651858.CD010287.pub3
World Health Organization. WHO Classification of Anovulation. In: Rowe PJ, Comhaire FH, Hargreave TB, Mahmoud AMA, eds. WHO Manual for the Standardized Investigation and Diagnosis of the Infertile Couple. Cambridge: Cambridge University Press; 2000.
American College of Obstetricians and Gynecologists. Management of Infertility in Women with Polycystic Ovary Syndrome. ACOG Practice Bulletin No. 194. Obstet Gynecol. 2018;131(6):e157-71. DOI: https://doi.org/10.1097/AOG.0000000000002656
Teede HJ, Misso ML, Costello MF, Dokras A, Laven J, Moran L, et al. Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Hum Reprod. 2018;33(9):1602-18. DOI: https://doi.org/10.1093/humrep/dey256
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