LETROZOLE COMPARED WITH CLOMPIHENE CITRATE FOR POLYCYSTIC OVARIAN SYNDROME: A SYSTEMATIC REVIEW

Authors

  • Dea Nabila Ratu Alicia Faculty of Medicine, University of Malahayati, Indonesia Author

DOI:

https://doi.org/10.53555/nnmhs.v9i5.1701

Keywords:

Clompihene Citrate, Letrozole, Ovulation, Polycystic Ovarian Syndrome (PCOS)

Abstract

According to the Consensus on the Management of PCOS, polycystic ovary syndrome, is an endocrine condition that produces oligo-anovulation, clinical and biochemical symptoms of hyperandrogenism, and distinctive ovarian morphological characteristics on ultrasonographic examination. PCOS is also associated with a higher risk of endometrial cancer. Both hyperandrogenism and anovulation are difficult conditions to manage. PCOS women often have higher GnRH pulsatility, which in turn causes increased pituitary LH secretion and an elevated LH/FSH ratio. Granulosa cells are responsible for the conversion of androgens to estrogen and the maturation of follicles, while LH is responsible for promoting androgen synthesis in theca cells. Intraovarian androgens produce atresia in later antral stages, although they do boost initial follicle recruitment by increasing preantral and early antral follicle growth. In contrast to CC on its own, letrozole was shown to increase the number of live births, and the overall level of evidence was moderate. There was insufficient evidence that there was a difference in the rate of live births between CC plus metformin and CC alone, and the overall certainty of the evidence was poor due to the risk of bias and imprecision. When contrasted with the use of CC by itself, the potential benefit of CC in combination with metformin was more apparent in women whose baseline blood insulin or HOMA-IR values were higher than average. In comparison to clomiphene citrate, letrozole was related with higher rates of ovulation, pregnancy, and successful delivery of a live baby. Despite the fact that the quality of the data is inconsistent, one study recommends letrozole over clomiphene citrate as an ovulation induction medicine for women who have infertility and PCOS.

References

Azziz R, Carmina E, Chen Z, Dunaif A, Laven JSE, Legro RS, et al. Polycystic ovary syndrome. Nat Rev Dis Prim. 2016;2(1):1–18.

Aversa A, La Vignera S, Rago R, Gambineri A, Nappi RE, Calogero AE, et al. Fundamental concepts and novel aspects of polycystic ovarian syndrome: expert consensus resolutions. Front Endocrinol (Lausanne). 2020;11:516.

Ortiz-Flores AE, Luque-Ramírez M, Escobar-Morreale HF. Polycystic ovary syndrome in adult women. Med Clínica (English Ed. 2019;152(11):450–7.

Dumesic DA, Oberfield SE, Stener-Victorin E, Marshall JC, Laven JS, Legro RS. Scientific Statement on the Diagnostic Criteria, Epidemiology, Pathophysiology, and Molecular Genetics of Polycystic Ovary Syndrome.

Endocr Rev [Internet] 2015;36(5):487–525. Available from: https://doi.org/10.1210/er.2015-1018

YUAN Y, ZHAO J. Epidemiological features of polycystic ovary syndrome. Chinese J Pract Gynecol Obstet. 2019; 261–4.

Sachdeva G, Gainder S, Suri V, Sachdeva N, Chopra S. Comparison of the different PCOS phenotypes based on clinical metabolic, and hormonal profile, and their response to clomiphene. Indian J Endocrinol Metab. 2019;23(3):326.

Collée J, Mawet M, Tebache L, Nisolle M, Brichant G. Polycystic ovarian syndrome and infertility: overview and insights of the putative treatments. Gynecol Endocrinol Off J Int Soc Gynecol Endocrinol. 2021 Oct;37(10):869– 74.

Sachdeva G, Gainder S, Suri V, Sachdeva N, Chopra S. Prediction of responsiveness to clomiphene citrate in infertile women with PCOS. J Reprod Infertil. 2019;20(3):143.

Ghasemian F, Esmaeilnezhad S. Metformin, clomiphene citrate and flutamide effects on oocyte ultrastructure status and quality in PCOS mouse model. Reprod Biomed Online. 2022;45(2):191–201.

Prajapati DP, Patel M, Dharamsi A. Beneficial effect of polyherbal formulation in letrozole induced Polycystic ovarian syndrome (PCOS). J Tradit Complement Med. 2022;12(6):575–83.

Bansal S, Goyal M, Sharma C, Shekhar S. Letrozole versus clomiphene citrate for ovulation induction in anovulatory women with polycystic ovarian syndrome: A randomized controlled trial. Int J Gynecol Obstet. 2021;152(3):345– 50.

Khakwani M, Parveen R, Yousaf S, Tareen AU. Efficacy of letrozole versus clomiphene citrate on ovulation induction in patients with polycystic ovarian syndrome. Pakistan J Med Sci. 2022;38(5):1155–8.

Wang L, Lv S, Li F, Bai E, Yang X. Letrozole Versus Clomiphene Citrate and Natural Cycle: Endometrial Receptivity During Implantation Window in Women With Polycystic Ovary Syndrome. Front Endocrinol (Lausanne). 2020;11:532692.

Mejia RB, Summers KM, Kresowik JD, Van Voorhis BJ. A randomized controlled trial of combination letrozole and clomiphene citrate or letrozole alone for ovulation induction in women with polycystic ovary syndrome. Fertil Steril. 2019 Mar;111(3):571-578.e1.

Al-Obaidi MT, Ali ZH, Al-Saadi WI, Al-Wasiti EAR, Al-Aubaidy H. Impact of letrozole versus clomiphene citrate on endometrial receptivity in Iraqi women with polycystic ovarian syndrome. J Clin Pharm Ther. 2019 Aug;44(4):618–22.

Witchel SF, Oberfield SE, Peña AS. Polycystic Ovary Syndrome: Pathophysiology, Presentation, and Treatment With Emphasis on Adolescent Girls. J Endocr Soc [Internet] 2019;3(8):1545–73. Available from: https://doi.org/10.1210/js.2019-00078

Hoeger KM, Dokras A, Piltonen T. Update on PCOS: consequences, challenges, and guiding treatment. J Clin Endocrinol Metab. 2021;106(3):e1071–83.

Chen W, Pang Y. Metabolic Syndrome and PCOS: Pathogenesis and the Role of Metabolites. Metabolites. 2021 Dec;11(12).

Wang R, Li W, Bordewijk EM, Legro RS, Zhang H, Wu X, et al. First-line ovulation induction for polycystic ovary syndrome: an individual participant data meta-analysis. Hum Reprod Update. 2019 Nov;25(6):717–32.

Legro RS, Brzyski RG, Diamond MP, Coutifaris C, Schlaff WD, Casson P, et al. Letrozole versus clomiphene for infertility in the polycystic ovary syndrome. N Engl J Med. 2014 Jul;371(2):119–29.

Franik S, Le Q-K, Kremer JA, Kiesel L, Farquhar C. Aromatase inhibitors (letrozole) for ovulation induction in infertile women with polycystic ovary syndrome. Cochrane database Syst Rev. 2022 Sep;9(9):CD010287.

Sharma S, Ghosh S, Singh S, Chakravarty A, Ganesh A, Rajani S, et al. Congenital malformations among babies born following letrozole or clomiphene for infertility treatment. PLoS One. 2014;9(10):e108219.

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Published

2023-05-29

How to Cite

Alicia, D. N. R. (2023). LETROZOLE COMPARED WITH CLOMPIHENE CITRATE FOR POLYCYSTIC OVARIAN SYNDROME: A SYSTEMATIC REVIEW. Journal of Advanced Research in Medical and Health Science (ISSN 2208-2425), 9(5), 94-99. https://doi.org/10.53555/nnmhs.v9i5.1701

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