다낭성난소증후군으로 인한 불임 여성에서 경구 배란유도제의 효능

A Meta-Meta-Analysis: Effectiveness of Oral Ovulation Induction Agents for Infertile Women with Polycystic Ovary Syndrome

Background: Polycystic ovary syndrome (PCOS) is the most common cause of anovulatory infertility. Clomiphene citrate (CC), letrozole (LE), metformin (M), and CC plus M (CCM) are available therapeutic options for PCOS-related infertility. Therefore, we conducted a meta-meta-analysis to provide summarized effect sizes for reproductive outcomes and to assist health providers in selecting appropriate ovulation induction agents (OIAs). Methods: This study used three databases to perform a meta-meta-analysis to evaluate the pooled estimates of ovulation rate (OR), live birth (LB), and pregnancy (P). Results: A total of 17 meta-analyses and 71 primary studies were included in this overview. There was a high overlap between primary studies, and the corrected covered area score was 10.12%. Compared to CC, LE significantly improved the OR per patient (RR 1.30, 95%CI 1.02-1.65), LB (RR 1.52, 95%CI 1.37-1.69), and P (RR 1.24, 95%CI 1.09-1.43). CCM resulted in a 1.30 times higher pregnancy rate than CC (95%CI 1.21-1.40). M was no more effective than CC in OR (RR 0.73, 95%CI 0.63-0.86) and LB (RR 0.85, 95%CI 0.75-0.97). Conclusion: Patients with PCOS-related infertility treated with LE have a higher chance of ovulation, live birth, and pregnancy than those treated with CC. CCM significantly increased the pregnancy rate compared to CC, and M monotherapy was not competitive with CC for reproductive outcomes.