Summary of findings for the main comparison. Glucocorticoid supplementation versus placebo for IVF or ICSI.
| Glucocorticoid supplementation versus placebo for IVF or ICSI | ||||||
| Patient or population: Patients undergoing IVF or ICSI Settings: Infertility clinics in University/Teaching hospitals Intervention: Glucocorticoid supplementation during ovarian stimulation Comparison: Placebo | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No of Participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| Placebo | Glucocorticoid supplementation | |||||
| Live birth rate | 147 per 1000 | 157 per 1000 (72 to 308) | OR 1.08 (0.45 to 2.58) | 212 (2 studies) | ⊕⊕⊝⊝ low1 | |
| Clinical pregnancy rate per woman/couple | 236 per 1000 | 343 per 1000 (233 to 473) | OR 1.69 (0.98 to 2.90) | 310 (2 studies) | ⊕⊕⊝⊝ low1 | |
| Multiple pregnancy rate per woman/couple | Only one event (in the glucocorticoid group) | OR 3.32 (0.12 to 91.60) | 20 (1 study) | ⊕⊝⊝⊝ very low1,2 | ||
| Miscarriage rate per woman | See footnote3 | OR 1.00 (0.05 to 18.57) | 20 (1 study) | ⊕⊝⊝⊝ very low1,2 | ||
| OHSS per woman | Not reported in the included studies | |||||
| Side‐effects per woman | Not reported in the included studies | |||||
| *The basis for the assumed risk is the median risk in the control groups. The corresponding risk (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; OR: Odds ratio. | ||||||
| GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate. | ||||||
1 Downgraded two levels for very serious imprecision: low number of events and wide confidence intervals
2 Downgraded one level for serious risk of bias: method of sequence generation not described
3 Data supplied by trial authors were incomplete. They reported 3 clinical pregnancies and 2 live births in each group, and one miscarriage in the placebo group. We decided to impute a second miscarriage, in the glucocorticoid group, although we accept that this could have been a stillbirth.