Institute of Integrated Traditional Chinese and Western Medicine and the Department of Integrated Traditional Chinese and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Obstet Gynecol. 2023 Mar 1;141(3):523-534. doi: 10.1097/AOG.0000000000005070. Epub 2023 Feb 2.
To estimate the effect of letrozole and clomiphene citrate in women with infertility and polycystic ovarian syndrome (PCOS).
MEDLINE through PubMed, Web of Science, EMBASE, Cochrane Library, and ClinicalTrials.gov were searched for relevant studies from inception to February 1, 2022. Two reviewers retrieved, filtered, and extracted data independently using the bibliographic software EndNote X9 and Excel workbook. We included randomized controlled trials (RCTs) reporting ovulation induction outcomes in women with infertility and PCOS treated with either letrozole or clomiphene citrate followed by timed intercourse or intrauterine insemination. The data were merged into a mean difference or risk ratio (RR) with 95% CI, depending on variable types.
TABULATION, INTEGRATION, AND RESULTS: Data collection and organization were conducted in accordance with the 2020 PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analyses) statement. Twenty-nine RCTs were eligible, which included 3,952 women and 7,633 ovulation induction cycles. We acquired evidence from 22 RCTs for the ovulation rate, 28 RCTs for the clinical pregnancy rate, and eight RCTs for live-birth rate. Pooled analysis indicated that letrozole treatment prevailed against clomiphene citrate in ovulation rate (RR 1.14, 95% CI 1.06-1.21, P <.001), clinical pregnancy rate (RR 1.48, 95% CI 1.34-1.63, P <.001), and live-birth rate (RR 1.49, 95% CI 1.27-1.74, P <.001).
Letrozole was associated with improved ovulation, pregnancy, and live-birth rates compared with clomiphene citrate. We recommend letrozole over clomiphene citrate as an ovulation induction drug in women with infertility and PCOS, although the quality of the evidence is mixed.
PROSPERO, CRD42022308777.
评估来曲唑和枸橼酸氯米酚在不孕合并多囊卵巢综合征（PCOS）女性中的疗效。
通过 MEDLINE 下的 PubMed、Web of Science、EMBASE、Cochrane 图书馆和 ClinicalTrials.gov，检索从建库至 2022 年 2 月 1 日与来曲唑或枸橼酸氯米酚治疗不孕合并 PCOS 患者诱导排卵结局相关的研究。两位审查员使用书目软件 EndNote X9 和 Excel 工作簿独立检索、筛选和提取数据。我们纳入了报道来曲唑或枸橼酸氯米酚治疗不孕合并 PCOS 患者诱导排卵结局的随机对照试验（RCT），随访至 timed intercourse 或宫腔内人工授精。根据变量类型，将数据合并为均数差或风险比（RR）及 95%CI。
列表、整合和结果：数据收集和组织符合 2020 年 PRISMA（系统评价和荟萃分析的首选报告项目）声明。29 项 RCT 符合纳入标准，共纳入 3952 名女性和 7633 个排卵诱导周期。我们从 22 项 RCT 中获得排卵率证据，从 28 项 RCT 中获得临床妊娠率证据，从 8 项 RCT 中获得活产率证据。汇总分析表明，来曲唑治疗在排卵率（RR 1.14，95%CI 1.06-1.21，P<.001）、临床妊娠率（RR 1.48，95%CI 1.34-1.63，P<.001）和活产率（RR 1.49，95%CI 1.27-1.74，P<.001）方面优于枸橼酸氯米酚。
与枸橼酸氯米酚相比，来曲唑可提高不孕合并 PCOS 女性的排卵、妊娠和活产率。虽然证据质量混杂，但我们建议在不孕合并 PCOS 女性中，将来曲唑作为促排卵药物使用。
PROSPERO，CRD42022308777。
