Please use this identifier to cite or link to this item: http://hdl.handle.net/2440/105590
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Type: Journal article
Title: Treatment strategies for women with WHO group II anovulation: systematic review and network meta-analysis
Author: Wang, R.
Kim, B.
Van Wely, M.
Johnson, N.
Costello, M.
Zhang, H.
Ng, E.
Legro, R.
Bhattacharya, S.
Norman, R.
Mol, B.
Citation: BMJ, 2017; 356:j138-1-j138-11
Publisher: BMJ Publishing Group
Issue Date: 2017
ISSN: 0959-8146
1756-1833
Statement of
Responsibility: 
Rui Wang, Bobae V Kim, Madelon van Wely, Neil P Johnson, Michael F Costello, Hanwang Zhang, Ernest Hung Yu Ng, Richard S Legro, Siladitya Bhattacharya, Robert J Norman, Ben Willem J Mol
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, 57 trials reporting on 8082 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 1.58, 95% confidence interval 1.25 to 2.00; 1.81, 1.35 to 2.42; respectively) and ovulation rates (1.99, 1.38 to 2.87; 1.55, 1.02 to 2.36; respectively). Letrozole led to higher live birth rates when compared with clomiphene alone (1.67, 1.11 to 2.49). Both letrozole and metformin led to lower multiple pregnancy rates compared with clomiphene alone (0.46, 0.23 to 0.92; 0.22, 0.05 to 0.92; respectively). Conclusions: In women with WHO group II anovulation, letrozole and the combination of clomiphene and metformin are superior to clomiphene alone in terms of ovulation and pregnancy. Compared with clomiphene alone, letrozole is the only treatment showing a significantly higher rate of live birth.
Keywords: Anovulation; infertility
Rights: This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/ by-nc/3.0/.
RMID: 0030063805
DOI: 10.1136/bmj.j138
Grant ID: http://purl.org/au-research/grants/nhmrc/1078444
Appears in Collections:Obstetrics and Gynaecology publications

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