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. 2019 Jan 16;2019(1):CD010290. doi: 10.1002/14651858.CD010290.pub3

Yarali 1999.

Methods Prospective, randomised trial
Duration, timing, and location of the trial: not stated
Sample size calculation: not stated
51 women randomised
3 cycles/woman
Ratio between uFSH and rFSH was approximately 2:1.
Per protocol and intention‐to‐treat analyses were performed
Participants Clomiphene citrate‐resistant WHO Group II chronic anovulatory women (see Notes)
Mean age (± SD) of the women in years was 27.8 (4.8) for the uFSH group and 30.0 (5.8) for the rFSH group
Body mass index (± SD) was 27.1 (5.5) and 27.1 (3.7), respectively
Duration of infertility in years (± SD) was 7.0 (5.6) and 9.0 (4.2), respectively
Number of women with primary infertility was 57.1% and 64.5%, respectively
LH:FSH ratio (± SD) was 2.4 (1.3) and 3.4 (5.5), respectively
Infertility work‐up consisted of endocrinology (FSH, prolactin, TSH, testosterone), tubal tests by hysterosalpingography or laparoscopy, or hysteroscopy, and semen analysis
Interventions uFSH versus rFSH as second‐line treatment
Treatment was started 3 to 5 days after a spontaneous, or progesterone‐induced menstrual bleed
Starting dose was 75 IU daily, and was maintained for up to 14 days unless follicular maturity was reached. After this, the dose was maintained, or increased by 37.5 IU according to individual response. The maximum allowed daily dose was 225 IU
hCG (10,000 IU, Profasi HP) was given when a single follicle of ≥ 17 mm was detected. hCG was not given in cases of > 4 follicles of ≥ 15 mm
Outcomes Ovulation rate
Clinical pregnancy rate
Number of follicles
Endometrial thickness at the time of hCG administration
Duration of luteal phase
Incidence of OHSS
Total FSH dose and duration of stimulation
FSH level on day of hCG administration
Miscarriages
Multiple pregnancies
Number of cancellations
Notes Clomiphene‐resistant: consistent failure to ovulate with incremental doses of clomiphene citrate up to 150 mg/day in 3 previous cycles, or failure to conceive with the ovulatory dose during 6 previous cycles
Ovulation: mid‐luteal serum progesterone concentration of > 5 ng/mL
Clinical pregnancy: transvaginal ultrasound showing at least 1 gestational sac
OHSS: Not defined
Risk of bias
Bias Authors' judgement Support for judgement
Random sequence generation (selection bias) Low risk Randomisation was based on a participant number from a randomisation list corresponding with patient drug codes
Allocation concealment (selection bias) High risk Participant number from a randomisation list
Blinding of participants and personnel (performance bias) 
 All outcomes High risk No blinding was performed
Blinding of outcome assessment (detection bias) 
 All outcomes High risk No blinding was performed
Incomplete outcome data (attrition bias) 
 All outcomes Low risk 11 treatment cycles were cancelled because of > 4 follicles of > 15 mm, or a lack of response. ITT and per protocol analysis
Selective reporting (reporting bias) Low risk Intended outcomes reported.
Other bias Unclear risk Insufficient information was available to evaluate this risk
Funding Unclear risk rFSH was provided by Ares‐Serono