Eskandar Karine, Oliveira Juliana Almeida, Ribeiro Sandro Augusto, Chavez Matheus Pedrotti, Zotti Ana Isabela de Araujo, Dias Yasmin Jardim Meirelles, Novellino Andrea Mora de Marco
Pontificia Universidade Católica do Paraná Department of Medicine CuritibaPR Brazil Department of Medicine, Pontificia Universidade Católica do Paraná, Curitiba, PR, Brazil.
Department of Medicine Faculdade de Minas Belo HorizonteMG Brazil Department of Medicine, Faculdade de Minas, Belo Horizonte, MG, Brazil.
Rev Bras Ginecol Obstet. 2025 Apr 30;47. doi: 10.61622/rbgo/2025rbgo21. eCollection 2025.
We aimed to compare the efficacy and safety of letrozole and clomiphene versus letrozole alone for ovulation induction in patients with Polycystic Ovary Syndrome (PCOS).
We systematically searched EMBASE, PubMed, and Cochrane databases on October 31, 2024.
We included studies of women with PCOS treated with a combination of clomiphene and letrozole or letrozole alone to induce ovulation that reported any of the outcomes of interest, namely rate of mature follicles and ovulation, ovulation, pregnancy, miscarriages, endometrial thickness, and number of mature follicles.
We pooled odds ratios (OR) and mean difference (MD) with 95% confidence intervals (CI) using a random effects model using R statistical software, version 4.2.1. Heterogeneity was assessed with I statistics, and a random effects model was used.
Four RCTs and two observational studies comprising 592 patients were included. Combined therapy was associated with a higher rate of a mature follicle (OR 2.74; 95% CI 1.72-4.37; p< 0.001; I=0%) and ovulation (OR 2.55; 95% CI 1.57-4.12; p< 0.001; I=35.9%). The number of mature follicles, number of pregnancies, thickness of endometrial lining, and the incidence of adverse events, including headache, abdominal bloating, fatigue, back pain, breast discomfort, and night sweats, were similar between groups.
In women with anovulatory infertility secondary to PCOS, letrozole and clomiphene citrate combined therapy was associated with improved mature follicle and ovulation rates, with a similar safety profile compared to letrozole alone. However, no significant impact was observed on pregnancy rates.
我们旨在比较来曲唑与克罗米芬联合用药和单用 来曲唑对多囊卵巢综合征（PCOS）患者进行促排卵治疗的疗效和安全性。
我们于2024年10月31日系统检索了EMBASE、PubMed和Cochrane数据库。
我们纳入了关于使用克罗米芬和来曲唑联合用药或单用 来曲唑治疗PCOS女性以诱导排卵的研究，这些研究报告了任何感兴趣的结果，即成熟卵泡率和排卵率、排卵、妊娠、流产、子宫内膜厚度以及成熟卵泡数量。
我们使用R统计软件4.2.1版本，采用随机效应模型汇总优势比（OR）和平均差（MD）以及95%置信区间（CI）。使用I统计量评估异质性，并采用随机效应模型。
纳入了四项随机对照试验和两项观察性研究，共592例患者。联合治疗与更高的成熟卵泡率（OR 2.74；95%CI 1.72 - 4.37；p < 0.001；I = 0%）和排卵率（OR 2.55；95%CI 1.57 - 4.12；p < 0.001；I = 35.9%）相关。两组之间的成熟卵泡数量、妊娠次数、子宫内膜厚度以及不良事件发生率（包括头痛、腹胀、疲劳、背痛、乳房不适和盗汗）相似。
在PCOS继发无排卵性不孕症的女性中，来曲唑与枸橼酸克罗米芬联合治疗可提高成熟卵泡率和排卵率，与单用来曲唑相比安全性相似。然而，未观察到对妊娠率有显著影响。
