What do systematic reviews say?

Sildenafil vs Placebo or no active treatment

Sildenafil citrate showed no clear difference in all‐cause mortality compared with placebo or no therapy (moderate certainty).

• Interventions affecting the nitric oxide pathway versus placebo or no therapy for fetal growth restriction in pregnancy 2023 · Cochrane Headline outcomes only
  RR 1.01 [0.8, 1.27]
  5 studies · 516 participants
  Moderate

Sildenafil vs IV nitroglycerin

• Interventions affecting the nitric oxide pathway versus placebo or no therapy for fetal growth restriction in pregnancy 2023 · Cochrane Headline outcomes only
  no estimate extracted
  1 study · 23 participants
  Low

Sildenafil vs IV nitroglycerin

• Interventions affecting the nitric oxide pathway versus placebo or no therapy for fetal growth restriction in pregnancy 2023 · Cochrane Headline outcomes only
  no estimate extracted
  1 study · 23 participants
  Low

Sildenafil vs IV nitroglycerin

• Interventions affecting the nitric oxide pathway versus placebo or no therapy for fetal growth restriction in pregnancy 2023 · Cochrane Headline outcomes only
  no estimate extracted
  1 study · 23 participants
  Low

Sildenafil vs Placebo or no active treatment

Sildenafil citrate showed no clear difference in fetal mortality compared with placebo or no therapy (moderate certainty).

• Interventions affecting the nitric oxide pathway versus placebo or no therapy for fetal growth restriction in pregnancy 2023 · Cochrane Headline outcomes only
  RR 0.82 [0.6, 1.12]
  5 studies · 516 participants
  Moderate

Sildenafil vs Placebo or no active treatment

Sildenafil citrate showed no clear difference in neonatal mortality compared with placebo or no therapy (moderate certainty).

• Interventions affecting the nitric oxide pathway versus placebo or no therapy for fetal growth restriction in pregnancy 2023 · Cochrane Headline outcomes only
  RR 1.45 [0.9, 2.33]
  5 studies · 397 participants
  Moderate

Clomiphene citrate or letrozole with or without gonadotropins (with or without midcycle antagonist) vs gonadotropins (with GnRH agonists or midcycle antagonist)

Clomiphene citrate or letrozole with or without gonadotropins (with… showed no clear difference in live birth per woman compared with gonadotropins (with GnRH agonists or midcycle antagonist) (low certainty).

• Oral medications including clomiphene citrate or aromatase inhibitors with gonadotropins for controlled ovarian… 2017 · Cochrane Headline outcomes only
  RR 0.92 [0.66, 1.27]
  4 studies · 493 participants
  Low

Clomiphene citrate or letrozole with or without gonadotropins (with or without midcycle antagonist) vs gonadotropins (with GnRH agonists or midcycle antagonist)

• Oral medications including clomiphene citrate or aromatase inhibitors with gonadotropins for controlled ovarian… 2017 · Cochrane Headline outcomes only
  no estimate extracted
  3 studies · 136 participants
  Moderate

Clomiphene citrate or letrozole with or without gonadotropins (with or without midcycle antagonist) vs gonadotropins (with GnRH agonists or midcycle antagonist)

• Oral medications including clomiphene citrate or aromatase inhibitors with gonadotropins for controlled ovarian… 2017 · Cochrane Headline outcomes only
  no estimate extracted
  8 studies · 1203 participants
  Moderate

Clomiphene citrate or letrozole with or without gonadotropins (with or without midcycle antagonist) vs gonadotropins (with GnRH agonists or midcycle antagonist)

Clomiphene citrate or letrozole with or without gonadotropins (with… may leads to lower ovarian hyperstimulation syndrome per woman compared with gonadotropins (with GnRH agonists or midcycle antagonist) (low certainty).

• Oral medications including clomiphene citrate or aromatase inhibitors with gonadotropins for controlled ovarian… 2017 · Cochrane Headline outcomes only
  Peto OR 0.21 [0.11, 0.41]
  5 studies · 1067 participants
  Low

Clomiphene citrate or letrozole with or without gonadotropins (with or without midcycle antagonist) vs gonadotropins (with GnRH agonists or midcycle antagonist)

Clomiphene citrate or letrozole with or without gonadotropins (with… showed no clear difference in clinical pregnancy rate per woman compared with gonadotropins (with GnRH agonists or midcycle antagonist) (moderate certainty).

• Oral medications including clomiphene citrate or aromatase inhibitors with gonadotropins for controlled ovarian… 2017 · Cochrane Headline outcomes only
  RR 1 [0.86, 1.16]
  12 studies · 1998 participants
  Moderate

Clomiphene citrate or letrozole with or without gonadotropins (with or without midcycle antagonist) vs gonadotropins (with GnRH agonists or midcycle antagonist)

Clomiphene citrate or letrozole with or without gonadotropins (with… may leads to higher cancellation rate per woman compared with gonadotropins (with GnRH agonists or midcycle antagonist) (low certainty).

• Oral medications including clomiphene citrate or aromatase inhibitors with gonadotropins for controlled ovarian… 2017 · Cochrane Headline outcomes only
  RR 1.87 [1.43, 2.45]
  9 studies · 1784 participants
  Low

Clomiphene citrate or letrozole with or without gonadotropins (with or without midcycle antagonist) vs gonadotropins (with GnRH agonists or midcycle antagonist)

• Oral medications including clomiphene citrate or aromatase inhibitors with gonadotropins for controlled ovarian… 2017 · Cochrane Headline outcomes only
  no estimate extracted
  6 studies · 1098 participants
  Moderate

Clomiphene citrate or letrozole with or without gonadotropins (with or without midcycle antagonist) vs gonadotropins (with GnRH agonists or midcycle antagonist)

• Oral medications including clomiphene citrate or aromatase inhibitors with gonadotropins for controlled ovarian… 2017 · Cochrane Headline outcomes only
  no estimate extracted
  8 studies · 1481 participants
  Moderate

Clomiphene citrate or letrozole with or without gonadotropins (with or without midcycle antagonist) vs gonadotropins (with GnRH agonists or midcycle antagonist)

Clomiphene citrate or letrozole with or without gonadotropins (with… showed no clear difference in live birth per woman compared with gonadotropins (with GnRH agonist or midcycle antagonist) (low certainty).

• Oral medications including clomiphene citrate or aromatase inhibitors with gonadotropins for controlled ovarian… 2017 · Cochrane Headline outcomes only
  RR 1.16 [0.49, 2.79]
  2 studies · 357 participants
  Low

Clomiphene citrate or letrozole with or without gonadotropins (with or without midcycle antagonist) vs gonadotropins (with GnRH agonists or midcycle antagonist)

Clomiphene citrate or letrozole with or without gonadotropins (with… showed no clear difference in clinical pregnancy rate per woman compared with gonadotropins (with GnRH agonist or midcycle antagonist) (low certainty).

• Oral medications including clomiphene citrate or aromatase inhibitors with gonadotropins for controlled ovarian… 2017 · Cochrane Headline outcomes only
  RR 0.85 [0.64, 1.12]
  8 studies · 1462 participants
  Low

Clomiphene citrate or letrozole with or without gonadotropins (with or without midcycle antagonist) vs gonadotropins (with GnRH agonists or midcycle antagonist)

Clomiphene citrate or letrozole with or without gonadotropins (with… may leads to higher cancellation rate per woman compared with gonadotropins (with GnRH agonist or midcycle antagonist) (low certainty).

• Oral medications including clomiphene citrate or aromatase inhibitors with gonadotropins for controlled ovarian… 2017 · Cochrane Headline outcomes only
  RR 1.46 [1.18, 1.81]
  10 studies · 1601 participants
  Low

Exposure to clomiphene citrate for subfertility vs untreated subfertile women and endometrial cancer risk

It is very uncertain whether exposure to clomiphene citrate for subfertility changes endometrial cancer compared with untreated subfertile women and endometrial cancer risk (very low certainty).

• Risk of endometrial cancer in women treated with ovary‐stimulating drugs for subfertility 2017 · Cochrane Headline outcomes only
  RR 1.32 [1.01, 1.71]
  5 studies · 92849 participants
  Very low

Exposure to clomiphene citrate for subfertility vs general population and endometrial cancer risk

It is very uncertain whether exposure to clomiphene citrate for subfertility changes endometrial cancer compared with general population and endometrial cancer risk (very low certainty).

• Risk of endometrial cancer in women treated with ovary‐stimulating drugs for subfertility 2017 · Cochrane Headline outcomes only
  RR 1.87 [1, 3.48]
  4 studies · 19614 participants
  Very low

Exposure to clomiphene citrate and gonadotropins for subfertility vs untreated subfertile women and endometrial cancer risk

It is very uncertain whether exposure to clomiphene citrate and gonadotropins for subfertility changes endometrial cancer compared with untreated subfertile women and endometrial cancer risk (very low certainty).

• Risk of endometrial cancer in women treated with ovary‐stimulating drugs for subfertility 2017 · Cochrane Headline outcomes only
  RR 1.18 [0.57, 2.44]
  2 studies · 6345 participants
  Very low