Table 3. GRADE quality assessment of Comparison 2: comparing clomiphene citrate, metformin plus LC versus clomiphene citrate, metformin plus placebo.

Certainty assessment						Number of patients		Effect		Certainty
Total study	Risk of bias	Inconsistency	Indirectness	Imprecision	Other considerations	LC +CC + MTF	CC + MTF + placebo	Relative (95% CI)	Absolute (95% CI)
Outcome: Clinical pregnancy rate
1 RCT	not serious	not serious	not serious	seriousa	none	39/138 (28.3%)	9/136 (6.6%)	RR 4.27 (2.15 to 8.47)	216 more per 1,000 (from 76 more to 494 more)	$⨁⨁⨁○$ MODERATE
Outcome: Ovulation rate
1 RCT	not serious	not serious	not serious	seriousa	none	48/138 (34.8%)	15/136 (11.0%)	RR 3.15 (1.86 to 5.35)	237 more per 1,000 (from 95 more to 480 more)	$⨁⨁⨁○$ MODERATE
Outcome: BMI
1 RCT	not serious	not serious	not serious	seriousb	none	138	136	–	MD 1.1 higher (0.32 higher to 1.88 higher)	$⨁⨁⨁○$ MODERATE
Outcome: Serum FPG
1 RCT	not serious	not serious	not serious	seriousb	none	138	136	–	MD 5.1 lower (6.25 lower to 3.95 lower)	$⨁⨁⨁○$ MODERATE
Outcome: Serum LDL
1 RCT	not serious	not serious	not serious	seriousb	none	138	136	–	MD 25 lower (27.93 lower to 22.07 lower)	$⨁⨁⨁○$ MODERATE
Outcome: Serum total cholesterol
1 RCT	not serious	not serious	not serious	seriousb	none	138	136	–	MD 21 lower (24.14 lower to 17.86 lower)	$⨁⨁⨁○$ MODERATE
Outcome: Serum HDL
1 RCT	not serious	not serious	not serious	seriousb	none	138	136	–	MD 15.5 higher (12.42 higher to 18.58 higher)	$⨁⨁⨁○$ MODERATE
Outcome: Serum triglyceride
1 RCT	not serious	not serious	not serious	seriousb	none	138	136	–	MD 9 lower (11.46 lower to 6.54 lower)	$⨁⨁⨁○$ MODERATE
Outcome: serum FSH
1 RCT	not serious	not serious	not serious	seriousb	none	138	136	–	MD 0.63 lower (0.92 lower to 0.34 lower)	$⨁⨁⨁○$ MODERATE
Outcome: serum LH
1 RCT	not serious	not serious	not serious	seriousb	none	138	136	–	MD 2.36 lower (3.04 lower to 1.68 lower)	$⨁⨁⨁○$ MODERATE

Notes.

CI

Confidence interval

RR

Risk ratio

MD

Mean difference

RCT

Randomized controlled trial

GRADE

Working Group grades of evidence (GDT, 2022)

High certainty: We are very confident that the true effect lies close to that of the estimate of the effect.

Moderate certainty: 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 certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect.

Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect.

Explanations

^anumber of events <400.

^bnumber of participants <400.