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KMID : 1022920230110020088
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Journal of Korean Academy of Social & Managed Care Pharmacy
2023 Volume.11 No. 2 p.88 ~ p.97
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A Meta-Meta-Analysis: Effectiveness of Oral Ovulation Induction Agents for Infertile Women with Polycystic Ovary Syndrome
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Lee Ji-Eun
Lee So-Young
Jeong Eun-A
Kim Mi-Ri
Cho Eun
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Abstract
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BACKGROUND: Polycystic ovary syndrome (PCOS) is the most common cause of anovulatory infertility. Clomiphene citrate (CC), letrozole (LE), metformin (M), and CC plus M (CCM) are available therapeutic options for PCOS-related infertility. Therefore, we conducted a meta-meta-analysis to provide summarized effect sizes for reproductive outcomes and to assist health providers in selecting appropriate ovulation induction agents (OIAs).
METHODS: This study used three databases to perform a meta-meta-analysis to evaluate the pooled estimates of ovulation rate (OR), live birth (LB), and pregnancy (P).
RESULTS: A total of 17 meta-analyses and 71 primary studies were included in this overview. There was a high overlap between primary studies, and the corrected covered area score was 10.12%. Compared to CC, LE significantly improved the OR per patient (RR 1.30, 95%CI 1.02-1.65), LB (RR 1.52, 95%CI 1.37-1.69), and P (RR 1.24, 95%CI 1.09-1.43). CCM resulted in a 1.30 times higher pregnancy rate than CC (95%CI 1.21-1.40). M was no more effective than CC in OR (RR 0.73, 95%CI 0.63-0.86) and LB (RR 0.85, 95%CI 0.75-0.97).
CONCLUSION : Patients with PCOS-related infertility treated with LE have a higher chance of ovulation, live birth, and pregnancy than those treated with CC. CCM significantly increased the pregnancy rate compared to CC, and M monotherapy was not competitive with CC for reproductive outcomes.
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KEYWORD
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meta-meta-analysis, polycystic ovary syndrome, infertility, ovulation induction
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