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In the largest and most rigorous study so far (a 2024 Swedish analysis of 2.5 million children) researchers compared siblings, where one was exposed and the other wasnt

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doi:10.1007/s00125-015-3831-1 [41] Sizar O, Genova R, Gupta M

In an open uncontrolled trial in 20 men with idiopathic infertility and a low testosterone-to-estrogen ratio, three months of treatment with letrozole resulted in improved sperm motility and morphology, reduced sperm DNA fragmentation, increased testosterone-to-estrogen ratio, and four spontaneous pregnancies

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