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3,210 Multiple randomized controlled trials and meta-analyses have shown letrozole has a similar safety profile and is more effective than clomiphene citrate in women with PCOS

[DOI] [PMC free article] [PubMed] [Google Scholar] 51.Almeida L.S., Salomons G.S., Hogenboom F., Jakobs C., Schoffelmeer A.N

The mechanism does not involve receptor downregulation or tolerance in any known way, but the signal-to-noise ratio is simply too low based on available evidence