Luteal phase clomiphene citrate for ovulation induction in women with polycystic ovary syndrome: a systematic review and meta-analysis

Abstract

Objective: To assess the efficacy of late luteal phase clomiphene citrate (CC) administration relative to early follicular phase CC for ovulation induction for polycystic ovary syndrome (PCOS).

Study design: Review.

Materials and methods: A complete electronic databases including PubMed, Embase, The Cochrane Library, Web of Science, and CBM were searched for relevant randomized controlled trials (RCTs). The search was not restricted by language and publication time. Two reviewers selected trials and assessed trial quality by the Cochrane Handbook 5.1.0 independently.

Results: Four eligible RCT studies involving 708 women (934 cycles) were included. The results of the Meta-analysis: Late luteal phase group was associated with a number of higher total follicles (MD 1.82; 95% CI 0.86–2.78, p < 0.00001) and significant higher endometrial thickness on the day of HCG (MD 0.88; 95% CI 0.78–0.99, p < 0.00001) compared with early follicular group. There were no significant differences in the rate of pregnancy (RR 1.29; 95% CI 0.83–2.01, p = 0.26), ovulation rate (RR 0.99; 95% CI 0.86–1.14, p = 0.87), and abortion rate (RR 1.12; 95% CI 0.38 to 3.29, p = 0.84) between the two groups.

Conclusion: It appeared that late luteal phase CC for ovulation induction might be an effective method for ovulation induction in women with PCOS compared to conventional CC administration. Further intensive randomized-controlled studies should be warranted to define the efficacy of CC used in late luteal phase.

Chinese abstract

目的: 对多囊卵巢综合征黄体后期服用克罗米芬相对于早卵泡期服用克罗米芬促排卵疗效的评估。

研究设计: 回顾。

材料和方法: 搜索相关随机对照试验 (RCTs) 较完整的电子数据库有PubMed、荷兰医学文摘数据库、考克兰图书馆、科学网和中国生物医学文献数据库 (CBM) 。搜索不受语言和出版时间的限制。两名审稿人依据科克伦手册 (5.1.0版) 独立挑选试验并评估试验质量。

结果: 收录了四个合格的随机对照试验, 涉及708名女性 (934个月经周期) 。荟萃分析的结果显示: 与早卵泡期组相比, 黄体后期组在HCG日总卵泡数量增加(均差: 1.82; 95%, 置信区间: 0.86 ∼ 2.78, p < 0.00001), 子宫内膜显著增厚 (均差: 0.88; 95%, 置信区间: 0.78 ∼ 0.99, p < 0.00001)。两组的妊娠率(相对危险度: 1.29；95%, 置信区间: 0.83 ∼ 2.01, p = 0.26)、排卵率 (相对危险度: 0.99；95% 置信区间: 0.86 ∼ 1.14, p = 0.87)和流产率(相对危险度: 1.12；95% 置信区间: 0.38 ∼ 3.29, p = 0.84)没有显著差异。

结论: 看来关于PCOS女性的促排卵, 相较于常规服用克罗米芬, 在黄体后期服用克罗米芬促排卵可能是一种有效的方法。随机对照试验的进一步强化有必要明确黄体后期服用克罗米芬的疗效。

Keywords:

• Clomiphene citrate
• meta-analysis
• ovulation induction
• polycystic ovary syndrome
• randomized controlled trial

Acknowledgements

The authors appreciate Yu Wang for her helpful revision of this article. Jianbo Chang made substantial contributions to manual searching and academic help of this article. All other listed authors are worth applauded and appreciated.

Declaration of interest

The authors declare no potential conflicts of interest. This work was supported by NSFC (Nature Science Foundation of China) (81202959).