Letrozole vs clomiphene for pregnancy in polycystic ovarian syndrome

Letrozole which is an aromatase inhibitor, which blocks the conversion of testosterone to estrogen and thus blocks the negative feedback effect of estrogen on FSH. Therefore, the level of FSH increases and the chance of follicle maturity increases.

Clomiphene also works by increasing the level of FSH and LH. but clomphene acts directly on hypothalamus.

A reseach study published on New England Journal of Medicine on July 10 2014 (Richard S et all), showed that Letrozole is more effective than clomiphene in the treatment of infertility in polycystic ovarian syndrome. There were more live birth in letrozole group as compared to clomiphene group. Side effect profile was similar. 4 babies were born with birth defects in letrozole group and 1 baby was born with birth defect in clomiphene group. However, the incidence of twin pregnancies and triplets was higher in clomiphene group.

Reference:

Letrozole versus Clomiphene for Infertility in the Polycystic Ovary Syndrome
Richard S. July 2014. Link: https://www.nejm.org/doi/full/10.1056/NEJMoa1313517#t=article

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