Letrozole Versus Clomifene Citrate for Ovulation Induction in Polycystic Ovary Syndrome: A Comprehensive Review of Safety and Efficacy

Polycystic Ovary Syndrome (PCOS) is a prevalent endocrine disorder affecting women of reproductive age, with anovulation being a primary cause of infertility. Ovulation induction is a cornerstone of fertility management in PCOS patients. For decades, clomifene citrate (CC) has been the first-line pharmacotherapy. However, its limitations, including anti-estrogenic effects on the endometrium and cervical mucus, and a plateau in live birth rates, have prompted the search for more effective alternatives. Letrozole, an aromatase inhibitor, has emerged as a promising contender. This comprehensive review critically evaluates the safety and efficacy profiles of letrozole compared to clomifene citrate for ovulation induction in women with PCOS. We synthesize evidence from randomized controlled trials, meta-analyses, and systematic reviews, focusing on key outcomes such as ovulation rates, pregnancy rates, live birth rates, multiple pregnancy rates, and adverse events. The current literature suggests that letrozole offers comparable or superior ovulation and live birth rates with a potentially more favorable safety profile, particularly regarding the incidence of multiple pregnancies. Further research is warranted to solidify long-term outcomes and optimize individualized treatment protocols.