Impact of pharmacological Interventions on fertility outcomes in women with polycystic ovary syndrome: a systematic review and meta-analysis of randomised controlled trials
Abstract
Background: Polycystic ovary syndrome (PCOS) is an endocrine condition
associated with sub-fertility, infertility and poor reproductive
outcomes. Objectives: To review the effectiveness of different
pharmacological interventions on fertility outcomes in women with PCOS.
Search Strategy: We searched PubMed, MEDLINE, Scopus, Embase, Cochrane
Library, Web of Science in April 2020 and updated the search in PubMed
March 2021. Selection Criteria: Two independent reviewers selected
studies, and only randomised controlled trials (RCTs) were included.
Data Collection and Analysis: Thirty-four RCTs that met the eligibility
criteria were used to calculate odds ratios (OR) and the 95% confidence
interval (95% CI) using the random effect model. Main Results: There
was a significant increase in pregnancy rate with follicular stimulating
hormone (FSH) vs clomiphene citrate (CC)+ metformin (Odd Ratio(OR):4.08;
95%CI:1.12-14.83,I²=79%), Letrozole vs CC (OR: 1.58; 95%CI:
1.34-1.86, I²= 0%), metformin vs placebo(OR: 3.00; 95%CI: 1.95-4.59,
I²= 0%) and with CC+ metformin vs CC (OR: 1.48; 95%CI: 1.02-2.16, I²=
39%). There were significant increases in ovulation rate with CC+
metformin vs FSH (OR: 0.09; 95%CI: 0.02-0.37, I² = 75%), CC+ metformin
vs CC (OR: 2.04; 95%CI: 1.35-3.08, I² = 63%) and with Letrozole vs CC
(OR: 1.60; 95%CI: 1.02-2.52, I²= 88%). A significant increase in live
birth with Letrozole vs CC (OR: 1.63; 95%CI: 1.21-2.21, I² = 0%) was
observed. Conclusions: CC, letrozole alone or…
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Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid.
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