Clomiphene and other antioestrogens for ovulation induction in polycystic ovarian syndrome

Brown, Julie; Farquhar, Cynthia

doi:10.1002/14651858.cd002249.pub5

Cited by 64 publications

(59 citation statements)

References 74 publications

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“…On the other hand, Misso et al 7 found comparable ovulation rates between CC and letrozole (RR, 0.94; 95% CI, 0.82-1.07; I 2 = 0%) while the pregnancy rate was higher in the letrozole group, albeit there was no evidence of significant difference (RR, 1.53; 95% CI, 0.91-2.58; I 2 = 50%). Brown et al 6 found no evidence of a difference between CC and tamoxifen in ovulation and pregnancy rates while finding higher rates of both when adding dexamethasone to CC compared with CC alone, and these results are also in agreement with our study results. In women with unexplained subfertility undergoing intrauterine insemination, a recent meta-analysis reported no difference in EMT between CC and letrozole (WMD, −0.84; 95% CI, −1.97 to 0.28) 68 .…”

Section: Comparison With Previous Reviewssupporting

confidence: 93%

Effect of clomiphene citrate on endometrial thickness, ovulation, pregnancy and live birth in anovulatory women: systematic review and meta‐analysis

Gadalla

Huang

Wang

et al. 2017

Ultrasound in Obstet & Gyne

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Section: Comparison With Previous Reviewssupporting

confidence: 93%

Effect of clomiphene citrate on endometrial thickness, ovulation, pregnancy and live birth in anovulatory women: systematic review and meta‐analysis

Gadalla

Huang

Wang

et al. 2017

Ultrasound in Obstet & Gyne

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“…The antiestrogenic effect of CC may adversely affect the development of the endometrium, but the importance of this relative to implantation is uncertain . In a recent meta‐analysis, CC increased the odds of achieving clinical pregnancy compared with placebo, but the included studies were considered to be of low quality . Transient side effects like hot flushes and blurred vision are common.…”

Section: Resultsmentioning

confidence: 99%

Ovulation induction in polycystic ovary syndrome

Tanbo

Mellembakken

Bjercke

et al. 2018

Acta Obstet Gynecol Scand

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The objective of this narrative review was to suggest a rational order of treatment choices in anovulatory women with polycystic ovary syndrome (PCOS), for whom a multitude of treatment options exist. In obese/overweight women with PCOS the importance of weight reduction should be stressed. Inositol, a dietary supplement with a documented effect on ovulation and without adverse effects in the doses recommended, may be suggested. Additional first-line medical alternatives include insulin sensitizers, selective estrogen receptor modulators, and aromatase inhibitors. Of these, the aromatase inhibitor letrozole and the combination of clomiphene citrate and metformin have the highest rates of ovulation and live birth. Second-line treatments are ovarian electrocautery and low-dose follicle-stimulating hormone stimulation. Controlled ovarian stimulation with in vitro fertilization, should be considered the last option as it carries a significant risk of ovarian hyperstimulation syndrome in patients with PCOS.

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“…However, the higher rate of miscarriage was not maintained for post ART pregnancies. Given that there were no post ART pregnancies among BMI‐matched studies, the higher rate of hormonal medications in PCOS may have masked the impact of obesity on miscarriage. We also note that the higher prevalence of miscarriage in PCOS was maintained in hyperandrogenic phenotypes and for women from Australia and New Zealand and Africa.…”

Section: Discussionmentioning

confidence: 99%

Increased maternal pregnancy complications in polycystic ovary syndrome appear to be independent of obesity—A systematic review, meta‐analysis, and meta‐regression

et al. 2019

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Summary Polycystic ovary syndrome (PCOS) is associated with an increased risk of maternal pregnancy and delivery complications. However, the impact of clinical features of PCOS and other potential risk factors in PCOS is still unknown. We aimed to investigate the association of PCOS with maternal pregnancy and delivery complications with consideration of risk factors and potential confounders. The meta‐analysis included 63 studies. PCOS was associated with higher miscarriage, gestational diabetes mellitus, gestational hypertension, pre‐eclampsia, induction of labour, and caesarean section. The association of PCOS with these outcomes varied by geographic continent, PCOS phenotypes, and study quality. Pre‐eclampsia and induction of labour were not associated with PCOS on body mass index‐matched studies. No outcome was associated with PCOS on assisted pregnancies. Age was significantly associated with higher miscarriage on meta‐regression. There were no studies assessing perinatal depression. We confirm that PCOS is associated with an increased risk of maternal pregnancy and delivery complications. The association of PCOS with the outcomes is worsened in hyperandrogenic PCOS phenotypes, in specific geographic continents, and in the highest quality studies but disappears in assisted pregnancies. Future studies in PCOS are warranted to investigate proper timing for screening and prevention of maternal pregnancy and delivery complications with consideration of clinical features of PCOS.

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Clomiphene and other antioestrogens for ovulation induction in polycystic ovarian syndrome

Abstract: Analysis 2.1. Comparison 2 Antioestrogen versus antioestrogen, Outcome 1 Live birth rate (per woman

Cited by 64 publications

References 74 publications

Effect of clomiphene citrate on endometrial thickness, ovulation, pregnancy and live birth in anovulatory women: systematic review and meta‐analysis

Effect of clomiphene citrate on endometrial thickness, ovulation, pregnancy and live birth in anovulatory women: systematic review and meta‐analysis

Ovulation induction in polycystic ovary syndrome

Increased maternal pregnancy complications in polycystic ovary syndrome appear to be independent of obesity—A systematic review, meta‐analysis, and meta‐regression

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