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Review: aromatase inhibitors for ovulation induction
Robert F Casper1, Mohamed F M Mitwally
1Division of Reproductive Services, Fran and Lawrence Bloomberg Department of Obstetrics and Gynecology, Samuel Lunenfeld Research Institute, Mount Sinai Hospital and The University of Toronto, Toronto, Ontario, Canada M5S 2X9. rfcasper@aol.com
Aromatase inhibitors (AIs) show similar ovulation induction efficacy to clomiphene citrate (CC) but with fewer side effects and lower multiple pregnancy rates. Further randomized controlled trials are needed to confirm AIs as a potential replacement for CC.
Area of Science:
- Reproductive Endocrinology
- Pharmacology
Background:
- Clomiphene citrate (CC) has been the primary treatment for anovulation for 40 years.
- CC can cause antiestrogenic side effects and increase the risk of multiple pregnancies.
- Aromatase inhibitors (AIs) are proposed as an alternative ovulation induction method with a potentially improved side effect profile.
Purpose of the Study:
- To review the mechanisms of action for CC and AIs.
- To compare the efficacy of CC and AIs for ovulation induction.
Main Methods:
- Systematic review of published studies comparing CC and AI treatments.
- Included studies were both controlled and noncontrolled, with or without gonadotropins.
Main Results:
- AIs appear as effective as CC in inducing ovulation.
- AIs have no antiestrogenic side effects, lower estrogen levels, and lower multiple pregnancy rates than CC.
- In assisted reproductive technologies, AIs reduce FSH dosage and improve response in poor responders.
Conclusions:
- Preliminary data suggest AIs may replace CC due to similar efficacy and fewer side effects.
- More randomized controlled trials are needed to definitively compare CC and AIs for ovulation induction.
