Dataset Information

Treatment strategies for women with WHO group II anovulation: systematic review and network meta-analysis

ABSTRACT:

Objective

To compare the effectiveness of alternative first line treatment options for women with WHO group II anovulation wishing to conceive.

Design

Systematic review and network meta-analysis.

Data sources

Cochrane Central Register of Controlled Trials, Medline, and Embase, up to 11 April 2016.

Study selection

Randomised controlled trials comparing eight ovulation induction treatments in women with WHO group II anovulation: clomiphene, letrozole, metformin, clomiphene and metformin combined, tamoxifen, gonadotropins, laparoscopic ovarian drilling, and placebo or no treatment. Study quality was measured on the basis of the methodology and categories described in the Cochrane Collaboration Handbook. Pregnancy, defined preferably as clinical pregnancy, was the primary outcome; live birth, ovulation, miscarriage, and multiple pregnancy were secondary outcomes.

Results

Of 2631 titles and abstracts initially identified, 54 trials reporting on 7173 women were included. All pharmacological treatments were superior to placebo or no intervention in terms of pregnancy and ovulation. Compared with clomiphene alone, both letrozole and the combination of clomiphene and metformin showed higher pregnancy rates (odds ratio 1.69, 95% confidence interval 1.33 to 2.14; 1.71, 1.28 to 2.27; respectively). Letrozole led to higher live birth rates when compared with clomiphene alone (1.67, 1.11 to 2.49). Metformin led to lower multiple pregnancy rates compared with clomiphene alone (0.22, 0.05 to 0.93).

Conclusions

In women with WHO group II anovulation, letrozole and the combination of clomiphene and metformin are superior to clomiphene alone in terms of pregnancy. Compared with clomiphene alone, letrozole is the only treatment showing a significantly higher rate of live birth.

Systematic review registration

PROSPERO CRD42015027579.

Readers' note

This is the second version of this paper. The original version was corrected following the retraction of two studies and removal of another which were ineligible (references 40, 41, and 75 of the original paper). These studies are not shown in this version. A tracked changes version of the original version is attached as a supplementary file to the correction notice, which explains the issue further.

SUBMITTER: Wang R

PROVIDER: S-EPMC5421445 | biostudies-literature | 2017 Jan

REPOSITORIES: biostudies-literature

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Publications

Treatment strategies for women with WHO group II anovulation: systematic review and network meta-analysis

Wang Rui R Kim Bobae V BV van Wely Madelon M Johnson Neil P NP Costello Michael F MF Zhang Hanwang H Ng Ernest Hung Yu EH Legro Richard S RS Bhattacharya Siladitya S Norman Robert J RJ Mol Ben Willem J BW

BMJ (Clinical research ed.) 20170131

<h4>Objective</h4>To compare the effectiveness of alternative first line treatment options for women with WHO group II anovulation wishing to conceive.<h4>Design</h4>Systematic review and network meta-analysis.<h4>Data sources</h4>Cochrane Central Register of Controlled Trials, Medline, and Embase, up to 11 April 2016.<h4>Study selection</h4>Randomised controlled trials comparing eight ovulation induction treatments in women with WHO group II anovulation: clomiphene, letrozole, metformin, clomip ...[more]

PMID: 28143834

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Dataset Information

Treatment strategies for women with WHO group II anovulation: systematic review and network meta-analysis

Objective

Design

Data sources

Study selection

Results

Conclusions

Systematic review registration

Readers' note

Publications

Treatment strategies for women with WHO group II anovulation: systematic review and network meta-analysis

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