Cochrane · systematic review · CD008528

Oral medications including clomiphene citrate or aromatase inhibitors with gonadotropins for controlled ovarian stimulation in women undergoing in vitro fertilisation

Kamath, MS, Maheshwari, A, Bhattacharya, S, 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
11
current version
GRADE rated
11
No studies
0
Included studies
NR
No studies 0 · 0%Ungraded 0 · 0%Very low 0 · 0%Low 6 · 54.5%Moderate 5 · 45.5%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

Show all 2 versions

Clomiphene citrate or letrozole with or without gonadotropins (with or without midcycle antagonist) compared to gonadotropins (with GnRH agonists or midcycle antagonist) in IVF and ICSI cycles in general population for controlled ovarian stimulation

Population: for controlled ovarian stimulation
6 questions
OutcomeEffectEvidenceStatus / GRADE
Live birth per woman
Clomiphene citrate or letrozole with or without gonadotropins (with or without midcycle antagonist) vs gonadotropins (with GnRH agonists or midcycle antagonist)
RR 0.92 [0.66, 1.27]4 studies · 493 participantsLow
Downgraded: risk of bias, imprecision
Ovarian hyperstimulation syndrome per woman
Clomiphene citrate or letrozole with or without gonadotropins (with or without midcycle antagonist) vs gonadotropins (with GnRH agonists or midcycle antagonist)
Peto OR 0.21 [0.11, 0.41]5 studies · 1067 participantsLow
Downgraded: risk of bias, imprecision
Clinical pregnancy rate per woman
Clomiphene citrate or letrozole with or without gonadotropins (with or without midcycle antagonist) vs gonadotropins (with GnRH agonists or midcycle antagonist)
RR 1 [0.86, 1.16]12 studies · 1998 participantsModerate
Downgraded: risk of bias
Cancellation rate per woman
Clomiphene citrate or letrozole with or without gonadotropins (with or without midcycle antagonist) vs gonadotropins (with GnRH agonists or midcycle antagonist)
RR 1.87 [1.43, 2.45]9 studies · 1784 participantsLow
Downgraded: risk of bias, inconsistency
Mean number of gonadotropin ampoules used per woman
Clomiphene citrate or letrozole with or without gonadotropins (with or without midcycle antagonist) vs gonadotropins (with GnRH agonists or midcycle antagonist)
no estimate extracted6 studies · 1098 participantsModerate
Downgraded: risk of bias, inconsistency
Mean number of oocytes retrieved per woman
Clomiphene citrate or letrozole with or without gonadotropins (with or without midcycle antagonist) vs gonadotropins (with GnRH agonists or midcycle antagonist)
no estimate extracted8 studies · 1481 participantsModerate
Downgraded: risk of bias, inconsistency

Clomiphene citrate or letrozole with or without gonadotropins (with or without midcycle antagonist) compared to gonadotropins (with GnRH agonist or midcycle antagonist) in IVF and ICSI cycles in poor responders for controlled ovarian stimulation

Population: Women undergoing controlled ovarian stimulation in IVF and ICSI cycles (poor responders)
5 questions
OutcomeEffectEvidenceStatus / GRADE
Live birth per woman
Clomiphene citrate or letrozole with or without gonadotropins (with or without midcycle antagonist) vs gonadotropins (with GnRH agonist or midcycle antagonist)
RR 1.16 [0.49, 2.79]2 studies · 357 participantsLow
Downgraded: risk of bias, imprecision
Clinical pregnancy rate per woman
Clomiphene citrate or letrozole with or without gonadotropins (with or without midcycle antagonist) vs gonadotropins (with GnRH agonist or midcycle antagonist)
RR 0.85 [0.64, 1.12]8 studies · 1462 participantsLow
Downgraded: risk of bias, imprecision
Cancellation rate per woman
Clomiphene citrate or letrozole with or without gonadotropins (with or without midcycle antagonist) vs gonadotropins (with GnRH agonist or midcycle antagonist)
RR 1.46 [1.18, 1.81]10 studies · 1601 participantsLow
Downgraded: risk of bias, inconsistency
Mean number of gonadotropin ampoules used per woman
Clomiphene citrate or letrozole with or without gonadotropins (with or without midcycle antagonist) vs gonadotropins (with GnRH agonist or midcycle antagonist)
no estimate extracted3 studies · 136 participantsModerate
Downgraded: risk of bias, inconsistency
Mean number of oocytes retrieved per woman
Clomiphene citrate or letrozole with or without gonadotropins (with or without midcycle antagonist) vs gonadotropins (with GnRH agonist or midcycle antagonist)
no estimate extracted8 studies · 1203 participantsModerate
Downgraded: risk of bias, inconsistency