Cochrane · systematic review · CD003053

Insulin‐sensitising drugs (metformin, rosiglitazone, pioglitazone, D‐chiro‐inositol) for women with polycystic ovary syndrome, oligo amenorrhoea and subfertility

Morley, LC, Tang, T, Yasmin, E, et al. · Cochrane Database of Systematic Reviews · 2017 · Cochrane Library

Gynaecology and Fertility2 versionsAMSTAR 2: not assessed

SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.

Questions

current version

GRADE rated

No studies

Included studies

No studies 3 · 14.3%Ungraded 0 · 0%Very low 5 · 23.8%Low 7 · 33.3%Moderate 6 · 28.6%High 0 · 0%

Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.

Questions and results

Current version only

Metformin compared to placebo or no treatment for women with polycystic ovary syndrome

Population: women with polycystic ovary syndrome, oligo amenorrhoea and subfertility

CD003053.PUB6 (current) · 6 questions

Outcome	Effect	Evidence	Status / GRADE
Live birth rate per woman Metformin vs placebo or no treatment	OR 1.59 [1, 2.51]	4 studies · 435 participants	Low Downgraded: risk of bias, imprecision
Adverse events (gastrointestinal) per woman Metformin vs placebo or no treatment	OR 4.76 [3.06, 7.41]	7 studies · 670 participants	Moderate Downgraded: risk of bias, inconsistency
Clinical pregnancy rate per woman Metformin vs placebo or no treatment	OR 1.93 [1.42, 2.64]	9 studies · 1027 participants	Moderate Downgraded: risk of bias
Menstrual frequency per woman Metformin vs placebo or no treatment	OR 1.72 [1.14, 2.61]	7 studies · 427 participants	Low Downgraded: risk of bias, inconsistency
Ovulation rate per woman Metformin vs placebo or no treatment	OR 2.55 [1.81, 3.59]	14 studies · 701 participants	Moderate Downgraded: risk of bias
Miscarriage rate per woman Metformin vs placebo or no treatment	OR 1.08 [0.5, 2.35]	4 studies · 748 participants	Low Downgraded: risk of bias, imprecision

Metformin combined with clomiphene citrate versus clomiphene citrate alone for women with polycystic ovary syndrome

Population: women with polycystic ovary syndrome

CD003053.PUB6 (current) · 6 questions

Outcome	Effect	Evidence	Status / GRADE
Live birth rate per woman Metformin combined with clomiphene citrate vs clomiphene citrate alone	OR 1.21 [0.92, 1.59]	9 studies · 1079 participants	Low Downgraded: risk of bias, imprecision
Adverse events (gastrointestinal) per woman Metformin combined with clomiphene citrate vs clomiphene citrate alone	OR 3.97 [2.59, 6.08]	3 studies · 591 participants	Moderate Downgraded: risk of bias
Clinical pregnancy rate per woman Metformin combined with clomiphene citrate vs clomiphene citrate alone	OR 1.59 [1.27, 1.99]	16 studies · 1529 participants	Moderate Downgraded: risk of bias
Menstrual frequency per woman Metformin combined with clomiphene citrate vs clomiphene citrate alone	no estimate extracted	NR	No studies
Ovulation rate per woman Metformin combined with clomiphene citrate vs clomiphene citrate alone	OR 1.57 [1.28, 1.92]	21 studies · 1624 participants	Moderate Downgraded: risk of bias, inconsistency
Miscarriage rate per woman Metformin combined with clomiphene citrate vs clomiphene citrate alone	OR 1.59 [1.03, 2.46]	9 studies · 1096 participants	Low Downgraded: risk of bias, imprecision

Metformin compared to clomiphene citrate for women with polycystic ovary syndrome

Population: women with polycystic ovary syndrome

CD003053.PUB6 (current) · 9 questions

Outcome	Effect	Evidence	Status / GRADE
Live birth rate per woman Participants with BMI < 30 kg/m2 or ≤ 32 kg/m2a Metformin vs clomiphene citrate	OR 1.71 [1, 2.94]	3 studies · 241 participants	Very low Downgraded: risk of bias, imprecision, inconsistency
Live birth rate per woman Participants with BMI ≥ 30 kg/m2a Metformin vs clomiphene citrate	OR 0.3 [0.17, 0.52]	2 studies · 500 participants	Very low Downgraded: risk of bias, imprecision, inconsistency
Adverse events (gastrointestinal) Metformin vs clomiphene citrate	no estimate extracted	NR	No studies
Clinical pregnancy rate per woman Participants with BMI < 30 kg/m2 or ≤ 32 kg/m2a Metformin vs clomiphene citrate	OR 1.56 [1.05, 2.33]	5 studies · 490 participants	Very low Downgraded: risk of bias, imprecision, inconsistency
Clinical pregnancy rate per woman Participants with BMI ≥ 30 kg/m2a Metformin vs clomiphene citrate	OR 0.34 [0.21, 0.55]	2 studies · 500 participants	Very low Downgraded: risk of bias, imprecision, inconsistency
Menstrual frequency Metformin vs clomiphene citrate	no estimate extracted	NR	No studies
Ovulation rate per woman Participants with BMI < 30 kg/m2b Metformin vs clomiphene citrate	OR 0.81 [0.51, 1.28]	4 studies · 312 participants	Low Downgraded: risk of bias
Ovulation rate per woman Participants with BMI ≥ 30 kg/m2b Metformin vs clomiphene citrate	OR 0.29 [0.2, 0.43]	2 studies · 500 participants	Low Downgraded: risk of bias
Miscarriage rate per woman Metformin vs clomiphene citrate	OR 0.92 [0.5, 1.67]	5 studies · 741 participants	Very low Downgraded: risk of bias

Metformin compared to placebo or no treatment for women with polycystic ovary syndrome, oligo amenorrhoea and subfertility

Population: Women with polycystic ovary syndrome, oligo amenorrhoea and subfertility

CD003053.PUB5 · 4 questions

Outcome	Effect	Evidence	Status / GRADE
Live birth rate Metformin vs placebo or no treatment	OR 1.8 [0.52, 6.16]	3 studies · 115 participants	Low Downgraded: risk of bias
Clinical pregnancy rate Metformin vs placebo or no treatment	OR 2.31 [1.52, 3.51]	8 studies · 707 participants	Moderate Downgraded: risk of bias
Ovulation rate Metformin vs placebo or no treatment	OR 1.81 [1.13, 2.93]	15 studies · 1208 participants	Low Downgraded: risk of bias
Miscarriage rate Metformin vs placebo or no treatment	OR 0.36 [0.09, 1.47]	3 studies · 279 participants	Moderate

D‐chiro‐inositol compared to placebo or no treatment for women with polycystic ovary syndrome, oligo amenorrhoea and subfertility

Population: Women with polycystic ovary syndrome, oligo amenorrhoea and subfertility

CD003053.PUB5 · 1 question

Outcome	Effect	Evidence	Status / GRADE
Ovulation D‐chiro‐inositol vs placebo or no treatment	OR 5.38 [0.7, 41.31]	2 studies · 327 participants	Moderate Downgraded: risk of bias

Rosiglitazone compared to placebo or no treatment for women with polycystic ovary syndrome, oligo amenorrhoea and subfertility

Population: Women with polycystic ovary syndrome, oligo amenorrhoea and subfertility

CD003053.PUB5 · 1 question

Outcome	Effect	Evidence	Status / GRADE
Ovulation rate Rosiglitazone vs placebo or no treatment	OR 1.91 [0.7, 5.22]	1 study · 64 participants	Very low Downgraded: risk of bias

Pioglitazone compared to placebo or no treatment for women with polycystic ovary syndrome, oligo amenorrhoea and subfertility

Population: Women with polycystic ovary syndrome, oligo amenorrhoea and subfertility

CD003053.PUB5 · 1 question

Outcome	Effect	Evidence	Status / GRADE
Improved menstrual pattern Pioglitazone vs placebo or no treatment	OR 8.88 [2.35, 33.61]	2 studies · 70 participants	Moderate Downgraded: risk of bias