Comparative effectiveness of 9 ovulation-induction therapies in patients with clomiphene citrate-resistant polycystic ovary syndrome: a network meta-analysis

Yiping Yu,Ruizhe Zhang,Jingyan He,Yingpu Sun,Xiaoyi Guo,Yujing Xiong,Yan Huang,Qingyun Du,Lanlan Fang

doi:10.1038/s41598-017-03803-9

Yiping Yu, Ruizhe Zhang + Show 7 more

Open Access

https://doi.org/10.1038/s41598-017-03803-9

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Abstract

The comparative efficacies of ovulation-induction treatments in patients with clomiphene citrate-resistant (CCR) polycystic ovary syndrome (PCOS) are not well known. Therefore, we conducted a network meta-analysis to rank the reproductive efficacies of these treatments. We ultimately included 26 randomized clinical trials with 2722 participants and 9 types of therapies: clomiphene citrate (CC), metformin, letrozole, follicle stimulating hormone (FSH), human menopausal gonadotropin (hMG), unilateral laparoscopic ovarian drilling (ULOD), bilateral laparoscopic ovarian drilling (BLOD), the combination of metformin with letrozole (metformin+letrozole), and the combination of metformin with CC (metformin+CC). The network meta-analysis demonstrates that hMG therapy result in higher pregnancy rates than BLOD, ULOD and CC therapies. Pregnancy, live birth and ovulation rates are significantly higher in metformin+letrozole and FSH groups than CC group. The abortion rate in the metformin+letrozole group is significantly lower than that in the metformin+CC group. Ranking probabilities show that, apart from gonadotropin (FSH and hMG), metformin+letrozole is also potentially more effective in improving reproductive outcomes than other therapies. In conclusion, owing to the low quality of evidence and the wide confidence intervals, no recommendation could be made for the treatment of ovulation-induction in patients with CCR PCOS.

Highlights

YipingYu, Lanlan Fang, Ruizhe Zhang, Jingyan He,Yujing Xiong, Xiaoyi Guo, Qingyun Du, Yan Huang & Yingpu Sun
It is counter-intuitive for clinicians to choose follicle stimulating hormone (FSH) or human menopausal gonadotropin (hMG) because of the high occurrence of ovarian hyperstimulation syndrome (OHSS) and multiple pregnancies associated with their use
A total of 2565 citations were retrieved based on electronic searches, and 2 additional studies were retrieved after checking the references of relevant reviews and guidelines

Summary

Introduction

YipingYu , Lanlan Fang, Ruizhe Zhang, Jingyan He,Yujing Xiong, Xiaoyi Guo, Qingyun Du, Yan Huang & Yingpu Sun. We included 26 randomized clinical trials with 2722 participants and 9 types of therapies: clomiphene citrate (CC), metformin, letrozole, follicle stimulating hormone (FSH), human menopausal gonadotropin (hMG), unilateral laparoscopic ovarian drilling (ULOD), bilateral laparoscopic ovarian drilling (BLOD), the combination of metformin with letrozole (metformin+letrozole), and the combination of metformin with CC (metformin+CC). Live birth and ovulation rates are significantly higher in metformin+letrozole and FSH groups than CC group. Apart from gonadotropin (FSH and hMG), metformin+letrozole is potentially more effective in improving reproductive outcomes than other therapies. Gonadotropin, including follicle stimulating hormone (FSH) and human menopausal gonadotropin (hMG), have been regarded as the second choice in patients who are insensitive to CC2 It is counter-intuitive for clinicians to choose FSH or hMG because of the high occurrence of OHSS and multiple pregnancies associated with their use. We took CC as the control to estimate the comparative efficacies of other treatments for women with CCR-PCOS

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