Efficacy of letrozole for the treatment of tubal ectopic pregnancy: A meta-analysis

•Tubal ectopic pregnancy (EP) is a life-threatening condition, especially if undiagnosed. The current management protocol of tubal EP consists of either surgical management, or medical management with methotrexate.•Recent studies, while few, have suggested that letrozole, an aromatase inhibitor, may play a role in the medical treatment of tubal EP.•A systematic review and meta-analysis was conducted to evaluate the effectiveness of letrozole in the medical treatment of tubal EP. retrospective or prospective studies reporting the treatment of tubal EP with letrozole were considered eligible for inclusion.•A total of 152 patients were included. Seventy-nine patients (51.97 %) were treated with letrozole, 39 patients (16.54 %) with methotrexate, and 34 patients (31.49 %) underwent surgical treatment.•Pooled data analysis supports the consistency of the effect of letrozole in reducing β-hCG over time at a comparable rate among studies, and that treatment with letrozole is superior to surgery and has the same efficacy as methotrexate.•This meta-analysis suggests that letrozole is a promising alternative to methotrexate and surgical therapy in the treatment of tubal EP. However, the data available today on letrozole treatment remain extremely sparse, which weakens any claims that can be made. Tubal ectopic pregnancy (EP) is a life-threatening condition, especially if undiagnosed or misdiagnosed, tipically in low income countries and/or where women have limited access to health care. The current management protocol of tubal EP consists of either surgical management, or medical management with methotrexate. Recent studies, while few, have suggested that letrozole, an aromatase inhibitor, may play a role in the medical treatment of tubal EP. To evaluate the effectiveness of letrozole alone in the medical treatment of tubal EP. Electronic databases were searched until 31 December 2023. Retrospective or prospective studies reporting the treatment of tubal EP with letrozole alone were considered eligible for inclusion. Pooled results were expressed as OR with 95 %CI. Heterogeneity was assessed using Higgins I2. Subgroup analysis was performed to compare outcomes according to time after intervention. Subgroup differences were checked through χ2 test. A total of 152 patients were included. Seventy-nine patients (51.97 %) were treated with letrozole, 39 patients (16.54 %) with methotrexate, and 34 patients (31.49 %) underwent surgical treatment. Pooled data analysis supp