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Polycystic ovary syndrome is described as a genetically diverse endocrine disorder affecting a substantial proportion of reproductive-aged women worldwide. Eight randomized controlled trials including 932 anovulatory infertile participants were synthesized using pooled odds ratios and mean differences from RevMan 5.4. The findings report a higher ovulation rate and increased endometrial thickness, with no significant difference in pregnancy rates.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":40,"@type":76,"position":81},"https://docshare.wps.com/document/research-report/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/efficacy-of-sequential-letrozole-and-gonadotropin-therapy-for-ovulation-induction-in-women-with-polycystic-ovary-syndrome-a-systematic-review-and-meta-analysis/439868/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/efficacy-of-sequential-letrozole-and-gonadotropin-therapy-for-ovulation-induction-in-women-with-polycystic-ovary-syndrome-a-systematic-review-and-meta-analysis/439868.png","ImageObject",300,407,{"name":92,"@type":93},"supergirl","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-01","2026-09-29",true,{"@type":102,"interactionType":103,"userInteractionCount":81},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What question does the meta-analysis address?","Question",{"text":112,"@type":113},"It assesses the effectiveness of sequential letrozole and gonadotropin therapy versus other ovulation induction regimens in women with PCOS.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"What outcomes showed benefit in the treatment group?",{"text":117,"@type":113},"Ovulation rates increased significantly, and endometrial thickness increased significantly compared with other regimens.",{"name":119,"@type":110,"acceptedAnswer":120},"Were pregnancy rates and follicle characteristics different?",{"text":121,"@type":113},"Pregnancy rates showed no statistically significant difference. The number of dominant follicles did not differ, while the size of dominant follicles decreased significantly.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},439868,1790778362,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":39,"category_name":40,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":81,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":139,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":145},962088121634,"https://ap-avatar.wpscdn.com/davatar_9964176cb1d06d4a9deccf72a44ae3dc","Systematic Review / Meta-analysis  \nEfficacy of sequential letrozole and gonadotropin therapy for ovulation induction in women with polycystic ovary syndrome: a systematic review and meta-analysis  \nWaseem Sajjad, MBBSa , Muhammad Nabeel Saddique, MBBSa , Fatima Shahid, MBBSa , Anam Ijaz, MDa , Muhammad Atif Bashir, MBBSa , Muhammad Safiullah, MBBSa , Ursula Abu Nahla, MBBSb ,*, Mohammad Rayyan Naseer, MBBSa , Malik Saad Hayat, MBBSa , Muhammad Hassan Zaman, MBBSa , Muhammad Usman, MBBSa , Basir Afzaal Gill, MBBSc  \nBackground: Polycystic ovarian syndrome (PCOS) is a genetically diverse endocrine disorder affecting 5–20% of reproductiveaged women worldwide. It is a significant cause of hyperandrogenism, anovulatory infertility, menstrual dysfunction, and hirsutism. This meta-analysis assesses the effectiveness of sequential letrozole and gonadotropin therapy as compared to other ovulation induction regimens in women with PCOS.  \nMethods: A comprehensive search was conducted through the PubMed, Embase, Cochrane, Scopus, [and ClinicalTrials.gov](and ClinicalTrials.gov)[ ](and ClinicalTrials.gov)[databases for articles relevant from inception up to March 2024](databases for articles relevant from inception up to March 2024) . Pooled outcome estimates were reported as odds ratios (ORs) and 95% confidence intervals (CIs) for dichotomous data, and as mean differences (MD) and 95% CI for continuous data. Statistical heterogeneity was assessed using I2 and χ2 statistics. All calculations were performed using RevMan 5.4.  \nResults: This meta-analysis included 8 randomized controlled trials involving 932 anovulatory infertile women with PCOS diagnosed by the Rotterdam Criteria. We found a statistically significant increase in ovulation rates (OR 1.74; 95% CI 1.02–2.99; P = 0.04; I2 = 27%) in the treatment group compared to other ovulation induction regimens. There was no difference in pregnancy rates (OR 1. 11; 95% CI 0 .66–1.87; P = 0.69; I2 = 60%) and number of dominant follicles (MD 0 .36; 95% CI −0.18 to 0 .91; P = 0. 19; I2 = 97%) . The treatment group showed a statistically significant reduction in the size of dominant follicles (mm) (MD −0 .27; 95% CI −0.95 to 0.41; P = 0.04; I2 = 88%) and an increase in endometrial thickness (mm) (MD 0.78; 95% CI 0.19–1.38; P = 0.010; I2 = 97%) . Conclusion: The treatment group saw a significant rise in ovulation rates and endometrial thickness. Sequential letrozole and gonadotropin therapy (LE + G) may hold clinical significance, but further large-scale, high-quality studies are necessary to establish conclusive evidence.  \nKeywords: clomiphene citrate, gonadotropins, infertility, letrozole, polycystic ovary syndrome  \nIntroduction  \nPolycystic ovarian syndrome (PCOS) is a highly prevalent, genetically complex, and heterogeneous endocrine disorder in reproductive-aged women, affecting 5–20% worldwide[1]. It is a common cause of hyperandrogenism, anovulatory infertility, menstrual dysfunction, and hirsutism. It appears to be associated with an increased risk of metabolic abnormalities such as insulin resistance, hyperinsulinism, type 2 diabetes mellitus, dyslipidemia,  \naDepartment of Obstetrics and Gynecology, King Edward Medical University, Lahore, Pakistan, bFaculty of Medicine, Hebron University, Hebron, Occupied Palestinian Territories and cBaim Institute for Clinical Research, Boston, Massachusetts, United States  \nSponsorships or competing interests that may be relevant to content are disclosed at the end of this article.  \n*Corresponding author. Address: Faculty of Medicine, Hebron University, P.O. Box 40, Hebron 3010, Occupied Palestinian Territories. Tel.: +972 59-432-9230.  \n[E-mail: uabunahla@gmail.com](E-mail: uabunahla@gmail.com) (U.A. Nahla).  \nCopyright © 2025 The Author(s). Published by Wolters Kluwer Health, Inc. This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in","cbCaisYFe2zJRlxz","https://ap.wps.com/l/cbCaisYFe2zJRlxz","pdf",1564814,13,"English","# Background\n# Methods\n# Results\n# Conclusion\n# Keywords\n# Introduction","[{\"question\":\"What question does the meta-analysis address?\",\"answer\":\"It assesses the effectiveness of sequential letrozole and gonadotropin therapy versus other ovulation induction regimens in women with PCOS.\"},{\"question\":\"What outcomes showed benefit in the treatment group?\",\"answer\":\"Ovulation rates increased significantly, and endometrial thickness increased significantly compared with other regimens.\"},{\"question\":\"Were pregnancy rates and follicle characteristics different?\",\"answer\":\"Pregnancy rates showed no statistically significant difference. The number of dominant follicles did not differ, while the size of dominant follicles decreased significantly.\"}]","Efficacy of sequential letrozole and gonadotropin therapy for ovulation induction in women with polycystic ovary syndrome - a systematic review and meta-analysis | PDF",1790690447,33]