Is combined letrozole and clomiphene superior to either as monotherapy: a systemic review and meta-analysis based on clinical trials

• Published in: Gynecological endocrinology 2024-12, Vol.40 (1), p.2405114
• Main Authors: Ashkar, Anusha, Jadoon, Bismeen, Ali Baig, Mirza Mehmood, Irfan, Shayan A, El-Gayar, Mona, Siddiqui, Fatima Zulfiqar
• Format: Article
• Language: English
• Subjects: clomiphene; Clomiphene - administration & dosage; Clomiphene - therapeutic use; Drug Therapy, Combination; effectiveness; Female; Fertility Agents, Female - administration & dosage; Fertility Agents, Female - adverse effects; Fertility Agents, Female - therapeutic use; Humans; Letrozole; Letrozole - administration & dosage; Letrozole - therapeutic use; ovulation; Ovulation Induction - methods; pcos; Polycystic Ovary Syndrome - drug therapy; Pregnancy; Pregnancy Rate; Randomized Controlled Trials as Topic
• ISSN: 0951-3590; 1473-0766; 1473-0766
• DOI: 10.1080/09513590.2024.2405114

This research was conducted to assess the therapeutic advantage of combined letrozole and clomiphene citrate versus monotherapy for polycystic ovarian syndrome (PCOS) patients. Five databases were searched using the search string: (letrozole and clomiphene) AND (clomiphene OR clomiphene citrate OR CC) AND (letrozole OR LE) AND (ovulation induc* OR fertility induc* OR fertility preserv*) AND (polycystic ovarian syndrome OR PCOS). All statistical analyses were conducted in Review Manager 5.4.1. Random effect-effect model was used to pool risk ratio (RR), mean difference (MD), and odds ratio (OR) and their corresponding 95% confidence interval (CI). Moreover, qualitative analysis was conducted to qualitatively analyze ovulation, secondary outcomes, and cycle characteristics. One clinical trial and three randomized clinical trials (RCTs) were used in the study. Two studies were used in a quantitative analysis showing that combination was superior for ovulation induction (RR = 1.86 [1.37, 2.53];