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Laparoscopic ovarian electrocautery versus gonadotropin therapy in infertile women with clomiphene citrate-resistant polycystic ovary syndrome: A systematic review and meta-analysis.

Moazami Goudarzi Z, Fallahzadeh H, Aflatoonian A, Mirzaei M - Iran J Reprod Med (2014)

Bottom Line: The decrease in multiple pregnancies rate in women undergoing LOD makes this option attractive.The increase in live birth rate in the gonadotropin group may be because of the higher rate of multiple pregnancies in these women.However, more focus on the long-term effects of LOD on ovarian function is suggested.

View Article: PubMed Central - PubMed

Affiliation: International Campus, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.

ABSTRACT

Background: Some trials have compared laparoscopic ovarian drilling (LOD) with gonadotropins but, because of variations in study design and small sample size, the results are inconsistent and definitive conclusions about the relative efficacy of LOD and gonadotropins cannot be extracted from the individual studies.

Objective: To evaluate the relative efficacy of LOD and gonadotropins for infertile women with clomiphene citrate- resistant poly cystic ovary syndrome (PCOS).

Materials and methods: A complete electronic literature search in databases including EMBASE, MEDLINE, Cochrane Library and Google scholar for some specific keywords was accomplished. We contained randomized clinical trials comparing outcomes between LOD, without medical ovulation induction, and gonadotropins.

Results: Six trials, covering 499 women, reported on the primary outcome of pregnancy rate. There was no evidence of a difference in pregnancy rate when LOD compared with gonadotropins (OR: 0.534; 95% CI: 0.242-1.176, p=0.119, 6 trials, 499 women, I(2)=73.201%). There was evidence of significantly fewer live births following LOD compared with gonadotropin (OR: 0.446; 95% CI: 0.269-0.74, p=0.02, 3 trials, 318 women, I(2)=3.353%). The rate of multiple pregnancies was significantly lower in the LOD arm compared to the gonadotropins arm (OR: 0.127; 95% CI: 0.028-0.579, p=0.008, 3 trials, 307 women, I(2)=0%).

Conclusion: Our result revealed that there was no evidence of a significant difference in rates of clinical pregnancy and miscarriage in women with clomiphene citrate-resistant PCOS undergoing LOD compared to the gonadotropin arm. The decrease in multiple pregnancies rate in women undergoing LOD makes this option attractive. The increase in live birth rate in the gonadotropin group may be because of the higher rate of multiple pregnancies in these women. However, more focus on the long-term effects of LOD on ovarian function is suggested.

No MeSH data available.


Related in: MedlinePlus

The confidence interval (95% confidence interval, 0.24–1.17) and odds ratio (OR: 0.53) of the pregnancies per women randomized in each of the studies and. Heterogeneity I2 =73.2% (df=5), p=0.002
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Figure 2: The confidence interval (95% confidence interval, 0.24–1.17) and odds ratio (OR: 0.53) of the pregnancies per women randomized in each of the studies and. Heterogeneity I2 =73.2% (df=5), p=0.002

Mentions: Overall, six trials covering 499 women, included in the pooled analysis for the discussed outcomes. All trials reported the primary outcome of pregnancy rate per women randomized. Although pregnancies were reported in 33% of women in the LOD arm and 55% in gonadotropins arm but overall summery effect was OR: 0.534 (95% CI: 0.242-1.176, p=0.119, 6 trials, 499 women, I2=73.201%). The result indicated that there was no evidence of significant difference in pregnancies when LOD compared with gonadotropins (Figure 2). This pattern of result was changed for the rate of live birth, OR: 0.446 (95% CI: 0.269-0.74, p=0.002, 3 trials, 318 women, I2=3.353%). It showed that, LOD was resulted a statistically significant decrease in the live birth rate compared to gonadotropins (Figure 3).


Laparoscopic ovarian electrocautery versus gonadotropin therapy in infertile women with clomiphene citrate-resistant polycystic ovary syndrome: A systematic review and meta-analysis.

Moazami Goudarzi Z, Fallahzadeh H, Aflatoonian A, Mirzaei M - Iran J Reprod Med (2014)

The confidence interval (95% confidence interval, 0.24–1.17) and odds ratio (OR: 0.53) of the pregnancies per women randomized in each of the studies and. Heterogeneity I2 =73.2% (df=5), p=0.002
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4233311&req=5

Figure 2: The confidence interval (95% confidence interval, 0.24–1.17) and odds ratio (OR: 0.53) of the pregnancies per women randomized in each of the studies and. Heterogeneity I2 =73.2% (df=5), p=0.002
Mentions: Overall, six trials covering 499 women, included in the pooled analysis for the discussed outcomes. All trials reported the primary outcome of pregnancy rate per women randomized. Although pregnancies were reported in 33% of women in the LOD arm and 55% in gonadotropins arm but overall summery effect was OR: 0.534 (95% CI: 0.242-1.176, p=0.119, 6 trials, 499 women, I2=73.201%). The result indicated that there was no evidence of significant difference in pregnancies when LOD compared with gonadotropins (Figure 2). This pattern of result was changed for the rate of live birth, OR: 0.446 (95% CI: 0.269-0.74, p=0.002, 3 trials, 318 women, I2=3.353%). It showed that, LOD was resulted a statistically significant decrease in the live birth rate compared to gonadotropins (Figure 3).

Bottom Line: The decrease in multiple pregnancies rate in women undergoing LOD makes this option attractive.The increase in live birth rate in the gonadotropin group may be because of the higher rate of multiple pregnancies in these women.However, more focus on the long-term effects of LOD on ovarian function is suggested.

View Article: PubMed Central - PubMed

Affiliation: International Campus, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.

ABSTRACT

Background: Some trials have compared laparoscopic ovarian drilling (LOD) with gonadotropins but, because of variations in study design and small sample size, the results are inconsistent and definitive conclusions about the relative efficacy of LOD and gonadotropins cannot be extracted from the individual studies.

Objective: To evaluate the relative efficacy of LOD and gonadotropins for infertile women with clomiphene citrate- resistant poly cystic ovary syndrome (PCOS).

Materials and methods: A complete electronic literature search in databases including EMBASE, MEDLINE, Cochrane Library and Google scholar for some specific keywords was accomplished. We contained randomized clinical trials comparing outcomes between LOD, without medical ovulation induction, and gonadotropins.

Results: Six trials, covering 499 women, reported on the primary outcome of pregnancy rate. There was no evidence of a difference in pregnancy rate when LOD compared with gonadotropins (OR: 0.534; 95% CI: 0.242-1.176, p=0.119, 6 trials, 499 women, I(2)=73.201%). There was evidence of significantly fewer live births following LOD compared with gonadotropin (OR: 0.446; 95% CI: 0.269-0.74, p=0.02, 3 trials, 318 women, I(2)=3.353%). The rate of multiple pregnancies was significantly lower in the LOD arm compared to the gonadotropins arm (OR: 0.127; 95% CI: 0.028-0.579, p=0.008, 3 trials, 307 women, I(2)=0%).

Conclusion: Our result revealed that there was no evidence of a significant difference in rates of clinical pregnancy and miscarriage in women with clomiphene citrate-resistant PCOS undergoing LOD compared to the gonadotropin arm. The decrease in multiple pregnancies rate in women undergoing LOD makes this option attractive. The increase in live birth rate in the gonadotropin group may be because of the higher rate of multiple pregnancies in these women. However, more focus on the long-term effects of LOD on ovarian function is suggested.

No MeSH data available.


Related in: MedlinePlus