Summary of findings for the main comparison. LOD compared to medical interventions for symptom relief in women with polycystic ovary syndrome.
| LOD compared to medical interventions for symptom relief in women with polycystic ovary syndrome | ||||||
| Patient or population: Women with symptoms of PCOS Setting: Clinic or hospital Intervention: Laparoscopic ovarian drilling (LOD) Comparison: medical interventions | ||||||
| Outcomes | Relative effect (95% CI) | Anticipated absolute effects* (95% CI) | Quality of the evidence (GRADE) | What happens | ||
| Without LOD | With LOD | Difference | ||||
| Menstrual regularity at 6 months LOD vs metformin N of participants: 236 (2 RCTs) LOD vs metformin + clomiphene N of participants: 332 (2 RCTs) LOD vs gonadotropins N of participants: 35 (1 RCT) LOD vs letrozole N of participants: 260 (1 RCT) LOD vs metformin + letrozole N of participants: 146 (1 RCT) |
Findings inconsistent and data unsuitable for pooling | Not calculable | ⊕⊝⊝⊝ VERY LOW 1, 2, 3 | |||
| OR 1.02 (0.64 to 1.64) | 70.6% | 71.0% (60.5 to 79.7) | 0.4% more (10 fewer to 9.2 more) | ⊕⊕⊝⊝ LOW 1, 3 | ||
| OR 19.20 (3.17 to 116.45) | 11.1% | 70.6% (28.4 to 93.6) | 59.5% more (17.3 more to 82.5 more) | ⊕⊕⊝⊝ LOW 1, 3 | ||
| OR 1.08 (0.64 to 1.84) | 68.8% | 70.4% (58.5 to 80.2) | 1.6% more (10.3 fewer to 11.4 more) | ⊕⊕⊝⊝ LOW 1, 3 | ||
| OR 0.95 (0.49 to 1.81) | 52.1% | 50.8% (34.7 to 66.3) | 1.3% fewer (17.3 fewer to 14.2 more) | ⊕⊕⊝⊝ LOW 1, 3 | ||
| Improvement in androgenic symptoms at 6 months (hirsutism/acne) ‐ LOD vs metformin N of participants: 126 (1 RCT) | OR 1.00 (0.42 to 2.37) | 79.4% | 79.4% (61.8 to 90.1) | 0.0% fewer (17.6 fewer to 10.7 more) | ⊕⊕⊝⊝ LOW 1, 3 | |
| Improvement in androgenic symptoms at 6 months (hirsutism/acne) ‐ LOD vs gonadotrophins N of participants: 50 (1 RCT) | Acne: OR 3.20 (0.33 to 30.94) Hirsutism: OR 2.31, (0.22 to 23.89) |
See comments | ⊕⊝⊝⊝VERY LOW 1, 4 | Acne: 4/29 without LOD, 1/21 with LOD Hirsutism: 3/29 without LOD, 1/21 with LOD |
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| Harms: GI Upset at 6 months ‐ LOD vs metformin + clomiphene
N of participants: 332 (2 RCTs) Harms: OHSS rates at 6 months ‐ LOD vs gonadotrophins N of participants: 33 (1 RCT) |
OR 0.05 (0.01 to 0.36) | 10.4% | 0.6% (0.1 to 4.0) | 9.9% fewer (10.3 fewer to 6.4 fewer) | ⊕⊕⊕⊝ MODERATE 1 | |
| OR 0.08 (0.00 to 1.61) | 25.0% | 2.6% (0.0 to 34.9) | 22.4% fewer (25 fewer to 9.9 more) | ⊕⊕⊝⊝ LOW 1, 3 | ||
| *The risk in the intervention group (and its 95% confidence interval) is based on the mean risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; OR: Odds 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 | ||||||
1Downgraded one level for serious risk of bias: Included studies not double‐blinded, and in some cases methods of randomization unclear. 2Downgraded two levels for very serious and unexplained heterogeneity: I2 = 85%, direction of effect inconsistent 3Downgraded one level for serious imprecision. 4Downgraded two levels for very serious imprecision: Broad confidence interval, very few events.