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https://hdl.handle.net/2440/74451
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dc.contributor.author | Misso, M. | - |
dc.contributor.author | Costello, M. | - |
dc.contributor.author | Garrubba, M. | - |
dc.contributor.author | Wong, J. | - |
dc.contributor.author | Hart, R. | - |
dc.contributor.author | Rombauts, L. | - |
dc.contributor.author | Melder, A. | - |
dc.contributor.author | Norman, R. | - |
dc.contributor.author | Teede, H. | - |
dc.date.issued | 2012 | - |
dc.identifier.citation | Human Reproduction Update, 2012; 19(1):2-11 | - |
dc.identifier.issn | 1355-4786 | - |
dc.identifier.issn | 1460-2369 | - |
dc.identifier.uri | http://hdl.handle.net/2440/74451 | - |
dc.description.abstract | BACKGROUND: Recent studies suggest that metformin may be more effective in women with polycystic ovary syndrome (PCOS) who are non-obese. The objective here is to determine and compare the effectiveness of metformin and clomiphene citrate for improving fertility outcomes in women with PCOS and a BMI, 32 kg/m2 (BMI 32 kg/m2 was used to allow for international differences in BMI values which determine access to infertility therapy through the public health system). METHODS: Databases were searched for English language articles until July 2011. Inclusion criteria: women of any age, ethnicity and weight with PCOS diagnosed by all current criteria, who are infertile; at least 1000 mg of any type of metformin at any frequency, including slow release and standard release, compared with any type, dose and frequency of clomiphene citrate. Outcomes: rates of ovulation, live birth, pregnancy, multiple pregnancies, miscarriage, adverse events, quality of life and cost effectiveness. Data were extracted and risk of bias assessed. A random effects model was used for meta-analyses of data, using risk ratios (relative risk). RESULTS: The search returned 4981 articles, 580 articles addressed metformin or clomiphene citrate and four randomized controlled trials (RCTs) comparing metformin with clomiphene citrate were included. Upon meta-analysis of the four RCTs, we were unable to detect a statistically significant difference between the two interventions for any outcome in women with PCOS and a BMI , 32 kg/m2, owing to significant heterogeneity across the RCTs. CONCLUSIONS: Owing to conflicting findings and heterogeneity across the included RCTs, there is insufficient evidence to establish a difference between metformin and clomiphene citrate in terms of ovulation, pregnancy, live birth, miscarriage and multiple pregnancy rates in women with PCOS and a BMI , 32 kg/m2. However, a lack of superiority of one treatment is not evidence for equivalence, and further methodologically rigorous trials are required to determine whether there is a difference in effectiveness between metformin and placebo (or no treatment) or between metformin and clomiphene citrate for ovulation induction in women with PCOS who are non-obese. Until then, caution should be exercised when prescribing metformin as first line pharmacological therapy in this group of women. | - |
dc.description.statementofresponsibility | Marie L. Misso, Michael F. Costello, Marie Garrubba, Jennifer Wong, Roger Hart, Luk Rombauts, Angela M. Melder, Robert J. Norman and Helena J. Teede | - |
dc.language.iso | en | - |
dc.publisher | Oxford Univ Press | - |
dc.rights | © The Author 2012. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. | - |
dc.source.uri | http://dx.doi.org/10.1093/humupd/dms036 | - |
dc.subject | Humans | - |
dc.subject | Polycystic Ovary Syndrome | - |
dc.subject | Infertility, Female | - |
dc.subject | Obesity | - |
dc.subject | Metformin | - |
dc.subject | Clomiphene | - |
dc.subject | Fertility Agents, Female | - |
dc.subject | Hypoglycemic Agents | - |
dc.subject | Body Mass Index | - |
dc.subject | Ovulation Induction | - |
dc.subject | Pregnancy Rate | - |
dc.subject | Ovulation | - |
dc.subject | Pregnancy | - |
dc.subject | Female | - |
dc.subject | Live Birth | - |
dc.subject | Randomized Controlled Trials as Topic | - |
dc.title | Metformin versus clomiphene citrate for infertility in non-obese women with polycystic ovary syndrome: a systematic review and meta-analysis | - |
dc.type | Journal article | - |
dc.contributor.organisation | Robinson Institute | - |
dc.identifier.doi | 10.1093/humupd/dms036 | - |
pubs.publication-status | Published | - |
dc.identifier.orcid | Norman, R. [0000-0002-3118-3896] | - |
dc.identifier.orcid | Teede, H. [0000-0001-7609-577X] | - |
Appears in Collections: | Aurora harvest Obstetrics and Gynaecology publications |
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