Use of Letrozole in a Patient with Polycystic Ovary Syndrome in Ovulation Induction

Abstract

Introduction: Polycystic Ovary Syndrome (PCOS) is a common endocrine disorder in reproductive-age women, affecting 8% to 20% of this population. It is characterized by menstrual irregularities, hyperandrogenism, and ovarian cysts, potentially leading to infertility and metabolic diseases. Ovulation induction is crucial for women with PCOS seeking pregnancy, and letrozole, an aromatase inhibitor, has emerged as an alternative to clomiphene citrate. Objective: A systematic review on the use of letrozole in ovulation induction in patients with PCOS. Methods: This study conducted a systematic review following PRISMA guidelines. The PICO model was used to structure the research, focusing on women with PCOS and comparing letrozole to clomiphene citrate. Searches were performed in databases such as SciELO, PubMed, and Cochrane, prioritizing articles published from 2000 to 2023. Inclusion criteria encompassed randomized clinical trials and systematic reviews. Results and Discussion: Results indicated that letrozole has ovulation rates between 60% and 85%, surpassing clomiphene’s 40% to 70%. The pregnancy rate was 30% with letrozole compared to 20% with clomiphene. Letrozole proved particularly effective in women unresponsive to clomiphene, with some cohorts achieving up to 90% ovulation. Additionally, it exhibited a milder side effect profile, such as hot flashes and headaches, while clomiphene is associated with more severe adverse effects. The combination of letrozole with metformin showed promising results in improving insulin resistance, a common issue in PCOS patients. Conclusion: Letrozole is an effective and safe alternative to clomiphene citrate for ovulation induction in women with PCOS. Its use can enhance ovulation and pregnancy rates while improving metabolic health, representing a significant advancement in managing infertility associated with PCOS.