Summary of findings 2. Human menopausal gonadotrophin or highly purified human menopausal gonadotrophin versus urinary follicle stimulating hormone for ovulation induction in women with polycystic ovarian syndrome.
| Human menopausal gonadotrophin or highly purified human menopausal gonadotrophin versus urinary follicle stimulating hormone for ovulation induction in women with polycystic ovarian syndrome | |||||
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Patient or population: women with polycystic ovarian syndrome (PCOS) undergoing ovulation induction
Settings: women visiting the outpatient clinic
Intervention: Human menopausal gonadotrophin (HMG) or highly purified HMG Comparison: urinary follicle stimulating hormone (uFSH) | |||||
| Outcomes | Anticipated absolute effects * (95% CI) | Relative effect (95% CI) |
No of Participants (studies) |
Quality of the evidence (GRADE) | |
| Risk with uFSH | Risk with HMG or HP‐HMG | ||||
| Live birth rate per woman | 179 per 1000 | 230 per 1000 (117 to 452) | RR 1.28 (0.65 to 2.52) |
138 (3 studies) | ⊕⊝⊝⊝ VERY LOW a,b |
| Incidence of multiple pregnancy (per woman) | 23 per 1000 | 48 per 1000 (12 to 203) | RR 2.13 (0.51 to 8.91) | 161 (4 studies) | ⊕⊝⊝⊝ VERY LOW a,b |
| Clinical pregnancy rate per woman | 203 per 1000 | 266 per 1000 (134 to 527) | RR 1.31 (0.66 to 2.59) | 102 (3 studies) | ⊕⊝⊝⊝ VERY LOW a,b |
| Miscarriage rate per woman | 82 per 1000 | 27 per 1000 (5 to 161) | RR 0.33 (0.06 to 1.97) | 98 (2 studies) | ⊕⊝⊝⊝ VERY LOW a,b |
| Incidence of OHSS per woman | No events c | 4/28 c | RR 7.07 (0.42 to 117.81) | 53 (2 studies) | ⊕⊝⊝⊝ VERY LOW a,b,d |
| * The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; RR: risk ratio; OHSS: ovarian hyperstimulation syndrome | |||||
| GRADE Working Group grades of evidence High quality: We are very confident that the true effect lies close to that of the estimate of the effect Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect | |||||
aDowngarded two levels for serious imprecision around the absolute effect (wide CI and small sample size) bDowngraded one level for inconsistency in results across studies cEvent rate derived from the raw data. A 'per thousand' rate is non‐informative in view of the scarcity of evidence and zero events in the control group
d Downgraded one level for inconsistent definition or for the lack of definition of OHSS; two of four studies did not report this outcome