Comparison of the pregnancy outcomes and the incidence of fetal congenital abnormalities in infertile women treated with letrozole and clomiphene citrate

Sene, Azadeh Akbari; Ghorbani, Sareh; Ashrafi, Mahnaz

doi:10.1111/jog.13644

Cited by 16 publications

(18 citation statements)

References 15 publications

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“…Our study followed pregnancy outcomes, and no fetal anomalies were documented in our study group, supporting the safety of letrozole [38][39][40][41][42]. Our study patients did not demonstrate any significant differences in pregnancy complications in either the aFET or the letrozole group.…”

Section: Afet Vs Ovu-fetsupporting

confidence: 72%

Ovulatory-Based FET Cycles May Achieve Higher Pregnancy Rates in the General Population and among Anovulatory Women

Aslih

Dorzia

Atzmon

et al. 2021

JCM

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This study evaluated which endometrial preparation protocol in frozen embryo transfer (FET) cycles provides the best results for polycystic ovarian syndrome (PCOS) patients and the general population. This retrospective study of 634 FET cycles was conducted 2016–2018. Cycles were divided into Group A: Artificial endometrial preparations for FET (aFET; n = 348), Group B: Ovulatory cycle (n = 286) to compare two methods of endometrial preparation for FET. Artificial endometrial preparation with exogenous estrogen and progesterone versus natural ovulation cycles, modified natural cycles using hCG for the final triggering and letrozole-induced ovulation with hCG. Anovulatory patients were analyzed separately. Anovulatory PCOS patients had significantly higher pregnancy rates with letrozole treatment compared with aFET cycles (44% vs. 22.5%; p = 0.044). For the entire cohort, ovulatory cycles and aFET were similar in terms of patient characteristics, demographics, infertility causes, treatment protocols and number of embryos transferred. Although the mean ESHRE score of the transferred embryos was higher in the aFET group, we found higher clinical pregnancy rate in the ovulatory cycle FET (41.3% vs. 27.3%, p < 0.0001). A better pregnancy rate was found after ovulatory cycle FET. In the ovulatory cycles, the outcome of letrozole-induced and non-induced cycles were comparable. PCOS patients, as well as the general population, may benefit from ovulation induced FET cycles, with significantly better outcomes in FET in ovulatory cycles.

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Section: Afet Vs Ovu-fetsupporting

confidence: 72%

Ovulatory-Based FET Cycles May Achieve Higher Pregnancy Rates in the General Population and among Anovulatory Women

Aslih

Dorzia

Atzmon

et al. 2021

JCM

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“…The current meta-analysis includes 4 RCTs [ 17 – 20 ] and 2 non-randomized controlled trials (NRCTs), [ 21 , 22 ] their evaluation of quality are judged by 2 methods, RCT is according to the Cochrane Handbook, NRCT is on the basis of the Newcastle–Ottawa Scale. In the Cochrane Handbook we use low, high or unclear to assess the quality in 7 fields which are consist of random sequence generation, allocation concealment, blinding of participants and personnel, blinding of outcome assessment, incomplete outcome data, selective outcome reporting and other sources of bias.…”

Section: Methodsmentioning

confidence: 99%

“…Six studies that contain 3413 participants all reported the total rate of pregnancy. Study Akbarisene [ 21 ] and Khanna [ 22 ] belong to NRCTs, therefore, we set a subgroup to further analyze. The result suggested that there was no significant difference between the 2 groups (RR= 1.06, I 2 = 11%, P = .38).…”

Section: Methodsmentioning

confidence: 99%

“…(RR= 0.61, I 2 = 0%, P = .03) 3 RCTs in this pool suggested there was no significant differences (RR= 0.64, I 2 = 27%, P = .22) with ascending heterogeneity. After eliminating the Fozan [ 18 ] or Akbari Sene [ 21 ] the result is according with the RCTs. However, that raised the heterogeneity.…”

Section: Methodsmentioning

confidence: 99%

“…On the basis of the work above, some RCTs [ 17 , 18 ] considered that LE had a superior efficacy as compared with CC in patients with unexplained infertility undergoing IUI. Otherwise, some RCTs [ 19 , 20 ] and a few retrospective studies [ 21 , 22 ] considered there were no significant differences between the 2 groups. Hence, Aromatase inhibitors that were originally developed and approved for treatment of breast cancer were currently being applied in alternatives to CC with an increased frequency, because it mimics the clomiphene action but without its peripheral antiestrogenic effect.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of clomiphene and letrozole for superovulation in patients with unexplained infertility undergoing intrauterine insemination

et al. 2020

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Background: With the medical advancement some studies put forward that letrozole (LE), a specific aromatase inhibitor with the function of reducing oestrogen synthesis, has recently been applied as a potentially better alternative compared with clomiphene citrate (CC), owing to that it has a superior efficacy as compared with CC in patients of unexplained infertility undergoing intrauterine insemination (IUI). However, there is no one study can clear and definite whether LE can replace the CC as first line drug. Objective: Our objective is to compare the LE with CC in the induction of ovulation in patients with unexplained infertility IUI. Method: Searching databases consist of all kinds of searching tools, such as Medline, The Cochrane Library, Embase, PubMed, etc. All the include studies should meet our demand of this meta-analysis: studies are comparison between LE and clomiphene for superovulation in patients with unexplained infertility undergoing IUI; the result includes one of outcomes at least or more; maybe in some literature they does not use LE but the meaning is as same as it, we also adopt them; the patients must be at least 1 side of the unobstructed fallopian tube confirmed by hysterosalpingography (HSG) or laparoscopy; uterus is normal that is confirmed by laparoscopy, hysteroscopy, ultrasound, etc; semen detection is normal or mildly abnormal that is based on WHO Standard (1999). In all interest outcomes below we take the full advantage of RevMan5 to assess, the main measure is risk ratio (RR) with 95%confidence. Result: Based on the current meta-analysis, we rigorously consider that LE has a likelihood to improve dominant follicles (MD= –0.56, I 2 = 100%, P = .04; MD= -0.39, I 2 = 73%, P = .0003, respectively) and reduces the miscarriage rate (RR= 0.61, I 2 = 0%, P = .03). There is no significant differences between the 2 groups in The total rate of pregnancy, pregnancy rate per cycle, multiple pregnancy and endometrial thickness. (RR= 1.06, I 2 = 11%, P = .38; RR= 1.09, I 2 = 7%, P = .32; RR= 0.79, I 2 = 0%, P = .46; respectively) Conclusion: Combined with the results of current systematic review and meta-analysis through subgroup analysis and sensitivity analysis, we can be cautious: in general, compared with CC, LE is an effective treatment in the IUI cycle, has a likelihood to improve dominant follicles and reduces the miscarriage rate.

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Diagnosis and Management of Infertility

Carson

Kallen

2021

JAMA

590

251

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Infertility, defined as the failure to achieve pregnancy after 12 months of regular unprotected sexual intercourse, affects 8.8% of US women aged 15 to 49 years 1 and is often associated with significant physical and emotional stress. This review summarizes current evidence regarding the pathophysiology, diagnosis, and management of infertility for heterosexual couples. 2 MethodsWe searched the PubMed and Cochrane databases for Englishlanguage studies of the epidemiology, diagnosis, and management of infertility published from January 2015 to November 2020, including randomized clinical trials (RCTs), meta-analyses, systematic reviews, and observational studies. Based on these criteria, 71 articles were identified, including 5 clinical trials, 31 systematic reviews, 29 meta-analyses, and 6 practice guidelines. We manually searched references for additional relevant publications. RCTs, metaanalyses, and systematic reviews applicable to a general medical readership were prioritized for inclusion.

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Comparison of the pregnancy outcomes and the incidence of fetal congenital abnormalities in infertile women treated with letrozole and clomiphene citrate

Abstract: Based on the findings of this study, it seems that the incidence of congenital anomalies in offspring after OI with letrozole is not increased compared to the CC group.

Cited by 16 publications

References 15 publications

Ovulatory-Based FET Cycles May Achieve Higher Pregnancy Rates in the General Population and among Anovulatory Women

Ovulatory-Based FET Cycles May Achieve Higher Pregnancy Rates in the General Population and among Anovulatory Women

Comparison of clomiphene and letrozole for superovulation in patients with unexplained infertility undergoing intrauterine insemination

Diagnosis and Management of Infertility

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