Summary of findings for the main comparison. Recombinant luteinizing hormone (rLH) combined with recombinant follicle‐stimulating hormone (rFSH) versus rFSH alone.
| Recombinant luteinizing hormone (rLH) combined with recombinant follicle‐stimulating hormone (rFSH) compared to rFSH alone | ||||||
| Population: women undergoing ovarian stimulation in IVF or ICSI treatment cycles Settings: assisted reproduction clinics Intervention: rLH combined with rFSH Comparison: rFSH alone | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No. of Participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| rFSH alone | rLH plus rFSH | |||||
| Live birth rate | 173 per 1000 | 217 per 1000 (151 to 302) | OR 1.32 (0.85 to 2.06) | 499 (4 studies) | ⊕⊕⊝⊝ very low1,2,4 | |
| OHSS incidence | 13 per 1000 | 5 per 1000 (2 to 13) | OR 0.38 (0.14 to 1.01) | 2178 (6 studies) | ⊕⊕⊝⊝ low3 | |
| Ongoing pregnancy rate | 206 per 1000 | 237 per 1000 (207 to 269) | OR 1.20 (1.01 to 1.42) | 3129 (19 studies) | ⊕⊕⊝⊝ moderate2 | |
| Miscarriage rate | 70 per 1000 |
65 per 1000 (45 to 93) |
OR 0.93 (0.63 to 1.36) |
1711 (13 studies) |
⊕⊕⊝⊝ moderate1 |
|
| Cancellation rate for low response | 67 per 1000 | 52 per 1000 (37 to 73) |
OR 0.77 (0.54 to 1.10) |
2251 (11 studies) |
⊕⊕⊝⊝ low1,2 | |
| Cancellation rate for imminent OHSS | 44 per 1000 | 27 per 1000 (18 to 40) |
OR 0.60 (0.40 to 0.89) |
2976 (8 studies) |
⊕⊕⊝⊝ very low2,4,5 | |
| *The basis for the assumed risk is the mean control group risk across studies. 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; ICSI: intracytoplasmic sperm injection; IVF: in‐vitro fertilisation; OHSS: ovarian hyperstimulation syndrome; OR: Odds ratio; rFSH: recombinant follicle‐stimulating hormone;rLH: recombinant luteinizing hormone. | ||||||
| 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 one level due to imprecision: effect estimate with wide confidence interval (wider than the interval 0.75 to 1.25) or low event rate. 2 Downgraded one level due to the presence of serious risk of bias in certain domains such as random sequence generation and allocation concealment. 3Downgraded two levels due to very serious imprecision with wide confidence interval (wider than the interval 0.75 to 1.25) and very low event rate.
4 Downgraded one level due to inconsistency (I2 >50%)
5Downgraded one level due to imprecision: findings are sensitive to choice of statistical model and are not statistically significant with use of a random effects model (OR 0.82, 95% CI 0.34 to 1.97)