Cochrane · systematic review · CD013505
Metformin for ovulation induction (excluding gonadotrophins) in women with polycystic ovary syndrome
Sharpe, A, Morley, LC, Tang, T, et al. · Cochrane Database of Systematic Reviews · 2019 · Cochrane Library
Gynaecology and FertilityAMSTAR 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
19
current version
GRADE rated
18
No studies
1
Included studies
NR
No studies 1 · 5.3%Ungraded 0 · 0%Very low 2 · 10.5%Low 12 · 63.2%Moderate 4 · 21.1%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
Metformin compared with placebo or no treatment for women with polycystic ovary syndrome
Population: women with polycystic ovary syndrome
| 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 [2.63, 6.09] | 7 studies · 713 participants | Moderate Downgraded: risk of bias, inconsistency |
Clinical pregnancy rate per woman Metformin vs placebo or no treatment | OR 1.98 [1.47, 2.65] | 11 studies · 1213 participants | Moderate Downgraded: risk of bias |
Ovulation rate per woman Metformin vs placebo or no treatment | OR 2.64 [1.85, 3.75] | 13 studies · 684 participants | Low Downgraded: risk of bias, inconsistency |
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
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Live birth rate per woman Metformin combined with clomiphene citrate vs clomiphene citrate alone | OR 1.27 [0.98, 1.65] | 10 studies · 1219 participants | Low Downgraded: risk of bias, imprecision |
Adverse events (gastrointestinal) per woman Metformin combined with clomiphene citrate vs clomiphene citrate alone | OR 4.26 [2.83, 6.4] | 6 studies · 852 participants | Moderate Downgraded: risk of bias, imprecision |
Clinical pregnancy rate per woman Metformin combined with clomiphene citrate vs clomiphene citrate alone | OR 1.62 [1.32, 1.99] | 19 studies · 1790 participants | Moderate Downgraded: risk of bias |
Ovulation rate per woman Metformin combined with clomiphene citrate vs clomiphene citrate alone | OR 1.65 [1.35, 2.03] | 22 studies · 1601 participants | Low Downgraded: risk of bias, inconsistency, publication bias |
Miscarriage rate per woman Metformin combined with clomiphene citrate vs clomiphene citrate alone | OR 1.35 [0.91, 2] | 10 studies · 1206 participants | Low Downgraded: risk of bias, imprecision |
Metformin compared with clomiphene citrate for women with polycystic ovary syndrome
Population: women with polycystic ovary syndrome
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Live birth rate per woman aParticipants with BMI < 30 kg/m2 or ≤ 32 kg/m2 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 aParticipants with BMI ≥ 30 kg/m2 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 womanaParticipants with BMI < 30 kg/m2 or ≤ 32 kg/m2 Metformin vs clomiphene citrate | OR 1.56 [1.06, 2.29] | 6 studies · 530 participants | Low Downgraded: risk of bias, imprecision |
Clinical pregnancy rate per woman aParticipants with BMI ≥ 30 kg/m2 Metformin vs clomiphene citrate | OR 0.34 [0.21, 0.55] | 2 studies · 500 participants | Low Downgraded: risk of bias, imprecision |
Ovulation rate per woman fParticipants with BMI < 30 kg/m2 Metformin vs clomiphene citrate | OR 0.8 [0.52, 1.25] | 5 studies · 352 participants | Low Downgraded: risk of bias, imprecision |
Ovulation rate per woman fParticipants with BMI ≥ 30 kg/m2 Metformin vs clomiphene citrate | OR 0.29 [0.2, 0.43] | 2 studies · 500 participants | Low Downgraded: risk of bias, imprecision |
Miscarriage rate per woman aParticipants with BMI < 30 kg/2 Metformin vs clomiphene citrate | OR 1.51 [0.62, 3.71] | 4 studies · 281 participants | Low Downgraded: risk of bias, imprecision |
Miscarriage rate per woman aParticipants with BMI ≥ 30 kg/m2 Metformin vs clomiphene citrate | OR 0.61 [0.27, 1.38] | 2 studies · 500 participants | Low Downgraded: risk of bias, imprecision |