Some drugs combination are more effective in treatment of anovulation

Emobileclinic Researchers Corner

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A new study has discovered that in women with WHO group II anovulation, letrozole and the combination of clomiphene and metformin are superior treatment to clomiphene alone in cases of ovulation and pregnancy.When compared with clomiphene alone, letrozole is the only treatment showing a significantly higher rate of live birth.

According to the study author, Infertility affects one in seven couples, and ovulation disorders account for a quarter of all cases. Normogonadotrophic anovulation, also classified as World Health Organization group II anovulation, is the most common category of anovulatory infertility. Within this group, polycystic ovary syndrome (PCOS) is by far the most prevalent cause.
The clinical manifestations of PCOS include oligomenorrhoea or amenorrhoea, hirsutism, and frequently infertility. From conception, women with PCOS and their infants are at increased risk of perinatal complications, including gestational diabetes, pre-eclampsia, preterm labour, and neonatal morbidity.

Safe and effective ovulation induction is important for women with WHO group II anovulation who wish to conceive, to avoid premature exposure to in vitro fertilisation, which is invasive, expensive, and associated with potentially higher chances of perinatal complications and congenital abnormalities.Several medical options are used to treat ovulation disorders and infertility, including oestrogen receptor modulators (such as clomiphene and tamoxifen), aromatase inhibitors (such as letrozole), insulin sensitising drugs (such as metformin), and direct hormonal stimulation of the ovaries (gonadotropins), with laparoscopic ovarian drilling being a surgical alternative.
In a bid to see which of the treatments are effective the author performed a systematic review and network meta-analysis to compare the effectiveness of different treatment options, including clomiphene, letrozole, metformin, clomiphene and metformin combined, tamoxifen, gonadotropins, laparoscopic ovarian drilling, and placebo or no treatment, in women with WHO group II anovulation, and to identify the best strategy for first line treatment.
Results Of 2631 titles and abstracts initially identified, 57 trials reporting on 8082 women were included. All pharmacological treatments were superior to placebo or no intervention in terms of pregnancy and ovulation. Compared with clomiphene alone, both letrozole and the combination of clomiphene and metformin showed higher pregnancy rates and ovulation rates . Letrozole led to higher live birth rates when compared with clomiphene alone. Both letrozole and metformin led to lower multiple pregnancy rates compared with clomiphene alone .
In conclusion, in women with WHO group II anovulation, both letrozole and the combination of clomiphene and metformin are superior to clomiphene alone in terms of ovulation and pregnancy. Letrozole is the only treatment showing a significantly higher rate of live birth when compared with clomiphene alone.

 

 

 

 

Source
BMJ.
Methodological problems in the use of indirect comparisons for evaluating healthcare interventions: survey of published systematic reviews.
Song F1, Loke YK, Walsh T, Glenny AM, Eastwood AJ, Altman DG.



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