Strategies to improve the outcomes of assisted reproduction in women with polycystic ovarian syndrome: a systematic review and meta-analysis-Abstract
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Abstract

OBJECTIVES:

To identify, appraise and summarize the current evidence regarding the efficacy of all strategies aiming to improve ART treatment in women with polycystic ovary syndrome (PCOS).

METHODS:

A comprehensive literature search of the standard medical databases was performed. The last electronic search was run in July-2015. The primary outcome measures were live birth / ongoing pregnancy and ovarian hyperstimulation syndrome (OHSS). The secondary outcome measures were clinical pregnancy and miscarriage.

RESULTS:

We screened 1,021, completely assessed 173 records, and finally included 66 studies in the quantitative analysis. Many different interventions were assessed, however overall quality of studies was low. We observed moderate quality evidence that there is no clinically relevant difference on live birth / ongoing pregnancy (RR = 0.95, 95% CI = 0.84-1.08), or clinical pregnancy (1.02, 0.91-1.15) when comparing antagonist and agonist protocols for ovarian stimulation. Additionally, we found low quality evidence that metformin improves live birth / ongoing pregnancy (1.28, 1.01-1.63) and clinical pregnancy rates (1.26, 1.04-1.53) when compared to placebo or no intervention. We further found low quality evidence that there is no clinically relevant difference on live birth / ongoing pregnancy (1.03, 0.80-1.34) and clinical pregnancy (0.99, 0.81-1.22) when comparing human menopausal gonadotropin (hMG) for inducing ovulation and artificial preparation with estradiol valerate for endometrial preparation for frozen embryo transfer. Low quality evidence suggests that mannitol compared to no intervention (0.54, 0.39-0.77) and antagonist protocols compared to agonist protocols (0.63, 0.49-0.80) reduce OHSS.

CONCLUSION:

There is low to moderate quality evidence suggesting that antagonist protocols are preferable to agonist ones, because they reduce the incidence of OHSS without interfering with clinical pregnancy and live birth for women with PCOS. Additionally there is low quality evidence pointing a benefit for metformin supplementation on clinical pregnancy and live birth; and that the ovulation induction and estradiol seems to be equally effective for endometrial preparation before frozen embryo transfer for women with PCOS. For all other interventions, the quality of the evidence is of very low quality, not allowing any meaningful conclusions.

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