JBRA Assisted Reproduction 2025;29(Suppl.2 SBRA 2025):162
Poster Presentation
29^th Annual Congress of the SBRA. São Paulo/SP - Brazil, 2025
doi: 10.5935/1518-0557.20263927

P-150. Letrozole in Ovulation Induction: A Cost-Effectiveness Review and Clinical Outcomes in PCOS and Clomiphene-Resistant Patients

Luísa Doria de Almeida¹, Beatriz Baptistella Cortez Teixeira da Rede¹, Liris Naomi Noguchi¹, Sabrina Paz Gonçalves da Silva¹, Julia Roverso Correa Silveira¹, Gabriel Monteiro Pinheiro¹

¹ Universidade Santo Amaro - São Paulo - SP - Brasil

Objective: Infertility affects about 10 to 15% of couples of reproductive age, with anovulation being a leading female factor. Ovulation induction is a cornerstone of infertility treatment, traditionally using clomiphene citrate. However, clomiphene is associated with adverse effects such as poor cervical mucus quality, suboptimal endometrial thickness, and increased risk of multiple gestations. Letrozole, an aromatase inhibitor initially approved for hormone-dependent breast cancer, has emerged as an effective off-label alternative for ovulation induction, particularly in women with polycystic ovary syndrome (PCOS) or clomiphene resistance. This review evaluates the cost-effectiveness and clinical outcomes of letrozole in ovulation induction, comparing it with other agents and highlighting its advantages, limitations, and potential for broader use in assisted reproduction.
Methods: This bibliographic review was conducted using the PUBMED database, focusing on the descriptors ‘'Letrozole'', ‘'Ovulation Induction'' and ‘'Cost-Benefit Analysis'' in articles from the last 20 years, comprising randomized controlled trials (RCTs), clinical trials, and systematic reviews. A total of 10 high-quality studies were selected based on relevance, methodological rigor, and clinical applicability, which included 10 reviews, clinical trials and RCTs.
Results: Letrozole demonstrated superior outcomes compared to clomiphene citrate in several studies, particularly in women with PCOS. Key findings include: Higher ovulation rates - up to 75–85% in PCOS patients -, increased clinical pregnancy and live birth rates, improved endometrial thickness and receptivity, lower incidence of ovarian hyperstimulation syndrome (OHSS), reduced risk of multiple pregnancies, lower gonadotropin requirements and monitoring costs. Letrozole also showed favorable results when used in combination with follicle-stimulating hormone (FSH) or in extended protocols, maintaining efficacy while minimizing estrogen exposure.
Conclusion: Letrozole is a safe, effective, and cost-efficient alternative for ovulation induction, especially in patients with normogonadotropic anovulation, PCOS, or clomiphene resistance. Its pharmacological profile allows for individualized treatment with reduced adverse effects and economic burden. Despite promising results, variability in stimulation protocols and limited RCTs with stratified data warrant further investigation. Future studies should aim to standardize protocols and explore long-term outcomes to support evidence-based, patient-centered reproductive care.