What do systematic reviews say?

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

Aromatase inhibitors with gonadotropins vs anti‐oestrogens with gonadotropins

It is very uncertain whether aromatase inhibitors with gonadotropins changes live birth rate per couple compared with anti‐oestrogens with gonadotropins (very low certainty).

• Agents for ovarian stimulation for intrauterine insemination (IUI) in ovulatory women with infertility 2021 · Cochrane Headline outcomes only
  OR 0.99 [0.38, 2.54]
  3 studies · 708 participants
  Very low

Aromatase inhibitors with gonadotropins vs anti‐oestrogens with gonadotropins

Aromatase inhibitors with gonadotropins showed no clear difference in multiple pregnancy rate per couple compared with anti‐oestrogens with gonadotropins (low certainty).

• Agents for ovarian stimulation for intrauterine insemination (IUI) in ovulatory women with infertility 2021 · Cochrane Headline outcomes only
  OR 1.31 [0.39, 4.37]
  4 studies · 901 participants
  Low

Aromatase inhibitors with gonadotropins vs anti‐oestrogens with gonadotropins

It is very uncertain whether aromatase inhibitors with gonadotropins changes clinical pregnancy rate per couple compared with anti‐oestrogens with gonadotropins (very low certainty).

• Agents for ovarian stimulation for intrauterine insemination (IUI) in ovulatory women with infertility 2021 · Cochrane Headline outcomes only
  OR 0.78 [0.57, 1.07]
  8 studies · 1244 participants
  Very low

Aromatase inhibitors with gonadotropins vs anti‐oestrogens with gonadotropins

It is very uncertain whether aromatase inhibitors with gonadotropins changes miscarriage rate per couple compared with anti‐oestrogens with gonadotropins (very low certainty).

• Agents for ovarian stimulation for intrauterine insemination (IUI) in ovulatory women with infertility 2021 · Cochrane Headline outcomes only
  OR 1.44 [0.75, 2.77]
  7 studies · 1164 participants
  Very low

Aromatase inhibitors with gonadotropins vs anti‐oestrogens with gonadotropins

Aromatase inhibitors with gonadotropins showed no clear difference in OHSS rate per couple compared with anti‐oestrogens with gonadotropins (low certainty).

• Agents for ovarian stimulation for intrauterine insemination (IUI) in ovulatory women with infertility 2021 · Cochrane Headline outcomes only
  OR 4.45 [0.75, 26.43]
  4 studies · 901 participants
  Low

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

It is very uncertain whether exposure to 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 1.55 [1.03, 2.34]
  4 studies · 17769 participants
  Very low

Exposure to gonadotropins for subfertility vs general population and endometrial cancer risk

It is very uncertain whether exposure to gonadotropins 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 2.12 [0.79, 5.64]
  2 studies · 1595 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

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

It is very uncertain whether exposure to clomiphene citrate and gonadotropins 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 2.99 [1.53, 5.86]
  3 studies · 7789 participants
  Very low

Summary of findings table ‐ Progestogens vs GnRH antagonists

• Progestogens for prevention of luteinising hormone (LH) surge in women undergoing controlled ovarian hyperstimulation… 2023 · Cochrane Headline outcomes only
  no estimate extracted
  4 studies · 952 participants
  Moderate

Summary of findings table ‐ Progestogens vs GnRH antagonists

• Progestogens for prevention of luteinising hormone (LH) surge in women undergoing controlled ovarian hyperstimulation… 2023 · Cochrane Headline outcomes only
  no estimate extracted
  1 study · 340 participants
  GRADE not reported

Summary of findings table ‐ Progestogens vs GnRH antagonists

• Progestogens for prevention of luteinising hormone (LH) surge in women undergoing controlled ovarian hyperstimulation… 2023 · Cochrane Headline outcomes only
  no estimate extracted
  2 studies · 492 participants
  GRADE not reported

Summary of findings table ‐ Progestogens vs GnRH antagonists

• Progestogens for prevention of luteinising hormone (LH) surge in women undergoing controlled ovarian hyperstimulation… 2023 · Cochrane Headline outcomes only
  no estimate extracted
  1 study · 120 participants
  GRADE not reported