Table 4. Summary of findings and GRADE quality assessment of primary and secondary outcomes for Comparison 3: comparing clomiphene citrate plus LC versus clomiphene citrate plus n acetylcysteine.

Certainty assessment						Number of patients		Effect		Certainty
Total study	Risk of bias	Inconsistency	Indirectness	Imprecision	Other considerations	LC+CC	CC + NAC	Relative (95% CI)	Absolute (95% CI)
Outcome: Clinical pregnancy rate
1 RCT	not serious	not serious	not serious	seriousa	none	25/80 (31.3%)	22/82 (26.8%)	RR 1.16 (0.72 to 1.89)	43 more per 1,000 (from 75 fewer to 239 more)	$⨁⨁⨁○$ MODERATE
Outcome: Ovulation rate
1 RCT	not serious	not serious	not serious	seriousa	none	38/80 (47.5%)	35/82 (42.7%)	RR 1.11 (0.79 to 1.56)	47 more per 1,000 (from 90 fewer to 239 more)	$⨁⨁⨁○$ MODERATE
Outcome: BMI
1 RCT	not serious	not serious	not serious	seriousb	none	80	82	–	MD 0.1 higher (0.78 lower to 0.98 higher)	$⨁⨁⨁○$ MODERATE
Outcome: Serum FPG
1 RCT	not serious	not serious	not serious	seriousb	none	80	82	–	MD 2.3 higher (1.02 higher to 3.58 higher)	$⨁⨁⨁○$ MODERATE
Outcome: serum LDL
1 RCT	not serious	not serious	not serious	seriousb	none	80	82	–	MD 12 lower (15.8 lower to 8.2 lower)	$⨁⨁⨁○$ MODERATE
Outcome: serum total cholesterol
1 RCT	not serious	not serious	not serious	seriousb	none	80	82	–	MD 24 lower (27.61 lower to 20.39 lower)	$⨁⨁⨁○$ MODERATE
Outcome: serum HDL
1 RCT	not serious	not serious	not serious	seriousb	none	80	82	–	MD 9.6 higher (5.3 higher to 13.9 higher)	$⨁⨁⨁○$ MODERATE
Outcome: serum triglyceride
1 RCT	not serious	not serious	not serious	seriousb	none	80	82	–	MD 19 lower (22.79 lower to 15.21 lower)	$⨁⨁⨁○$ MODERATE
Outcome: serum FSH
1 RCT	not serious	not serious	not serious	seriousb	none	80	82	–	MD 0.5 lower (0.84 lower to 0.16 lower)	$⨁⨁⨁○$ MODERATE
Outcome: serum LH
1 RCT	not serious	not serious	not serious	seriousb	none	80	82	–	MD 0.4 lower (1.51 lower to 0.71 higher)	$⨁⨁⨁○$ MODERATE

Notes.

CI

Confidence interval

RR

Risk ratio

MD

Mean difference

RCT

Randomized controlled trial

GRADE

Working Group grades of evidence

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.