Treatment strategies for women with WHO group II anovulation

Systematic review and network meta-analysis

Rui Wang, Bobae V. Kim, Madelon Van Wely, Neil P. Johnson, Michael F. Costello, Hanwang Zhang, Ernest Hung Yu Ng, Richard Legro, Siladitya Bhattacharya, Robert J. Norman, Ben Willem J. Mol

Research output: Contribution to journalArticle

28 Citations (Scopus)

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.

Original languageEnglish (US)
Article numberj138
JournalBMJ (Online)
Volume356
DOIs
StatePublished - Jan 1 2017

Fingerprint

letrozole
Anovulation
Clomiphene
Metformin
Ovulation
Live Birth
Pregnancy
Multiple Pregnancy
Therapeutics
Pregnancy Rate
Placebos
Network Meta-Analysis
Ovulation Induction
Birth Rate
Information Storage and Retrieval
Spontaneous Abortion
Tamoxifen
Gonadotropins
Randomized Controlled Trials
Odds Ratio

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

Wang, R., Kim, B. V., Van Wely, M., Johnson, N. P., Costello, M. F., Zhang, H., ... Mol, B. W. J. (2017). Treatment strategies for women with WHO group II anovulation: Systematic review and network meta-analysis. BMJ (Online), 356, [j138]. https://doi.org/10.1136/bmj.j138
Wang, Rui ; Kim, Bobae V. ; Van Wely, Madelon ; Johnson, Neil P. ; Costello, Michael F. ; Zhang, Hanwang ; Ng, Ernest Hung Yu ; Legro, Richard ; Bhattacharya, Siladitya ; Norman, Robert J. ; Mol, Ben Willem J. / Treatment strategies for women with WHO group II anovulation : Systematic review and network meta-analysis. In: BMJ (Online). 2017 ; Vol. 356.
@article{93182bb2c32c40c197b7f9de97bac8de,
title = "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, 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.",
author = "Rui Wang and Kim, {Bobae V.} and {Van Wely}, Madelon and Johnson, {Neil P.} and Costello, {Michael F.} and Hanwang Zhang and Ng, {Ernest Hung Yu} and Richard Legro and Siladitya Bhattacharya and Norman, {Robert J.} and Mol, {Ben Willem J.}",
year = "2017",
month = "1",
day = "1",
doi = "10.1136/bmj.j138",
language = "English (US)",
volume = "356",
journal = "The BMJ",
issn = "0267-0623",
publisher = "BMJ Publishing Group",

}

Wang, R, Kim, BV, Van Wely, M, Johnson, NP, Costello, MF, Zhang, H, Ng, EHY, Legro, R, Bhattacharya, S, Norman, RJ & Mol, BWJ 2017, 'Treatment strategies for women with WHO group II anovulation: Systematic review and network meta-analysis', BMJ (Online), vol. 356, j138. https://doi.org/10.1136/bmj.j138

Treatment strategies for women with WHO group II anovulation : Systematic review and network meta-analysis. / Wang, Rui; Kim, Bobae V.; Van Wely, Madelon; Johnson, Neil P.; Costello, Michael F.; Zhang, Hanwang; Ng, Ernest Hung Yu; Legro, Richard; Bhattacharya, Siladitya; Norman, Robert J.; Mol, Ben Willem J.

In: BMJ (Online), Vol. 356, j138, 01.01.2017.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Treatment strategies for women with WHO group II anovulation

T2 - Systematic review and network meta-analysis

AU - Wang, Rui

AU - Kim, Bobae V.

AU - Van Wely, Madelon

AU - Johnson, Neil P.

AU - Costello, Michael F.

AU - Zhang, Hanwang

AU - Ng, Ernest Hung Yu

AU - Legro, Richard

AU - Bhattacharya, Siladitya

AU - Norman, Robert J.

AU - Mol, Ben Willem J.

PY - 2017/1/1

Y1 - 2017/1/1

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=85011277647&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85011277647&partnerID=8YFLogxK

U2 - 10.1136/bmj.j138

DO - 10.1136/bmj.j138

M3 - Article

VL - 356

JO - The BMJ

JF - The BMJ

SN - 0267-0623

M1 - j138

ER -