The effectiveness of metformin and laparoscopic ovarian drilling treatment in women with clomiphene citrate-resistant polycystic ovary syndrome: A systematic review and meta-analysis
WU Lianzhi, HE Yi
Department of Obstetrics and Gynecology, Wuhan No.1 Hospital, Wuhan 430022, China
Abstract:Objective To evaluate the effectiveness of metformin and laparoscopic ovarian drilling (LOD) for ovulation induction in women with polycystic ovary syndrome (PCOS) after failure of clomiphene citrate (CC) treatment. Methods Based on the principles of evidence-based medicine, we used Cochrane systematic review method to retrieve randomized controlled trials (RCT) in Cochrane Library, PubMed, CNKI, CBM, and Wanfang, Chongqing VIP database published between 2002 and 2014. These publications were mainly about metformin therapy and laparoscopic ovarian drilling in the treatment of women with polycystic ovary syndrome (PCOS) after failure of CC treatment. Results Five RCTs were included, with a total of 688 patients. The results show that ovulation rate in metformin group were similar to LOD group (54.8%~71.9% vs. 53.2%~68.3%), resulting in an OR of 1.04 (0.86~1.27). The metformin group and the LOD group had similar pregnancy rate (13.1%~18.6% vs. 13.4%~17.2%), regular cycles (49.2%~68.8% vs. 41.5%~76.4%), and first trimester miscarriage rate (8.9%~18.2% vs. 9.5%~29.0%). Conclusion The findings from this meta-analysis do not indicate that LOD is superior to metformin for the treatment of PCOS after failure of CC treatment in ovulation rate, pregnancy rate, regular cycles, and first trimester abortion rate. Heterogeneity was a major confounder among studies. A large-scale randomized controlled trial is needed to further address this issue.
吴莲芝, 贺漪. 二甲双胍与腹腔镜卵巢打孔治疗有克罗米芬抵抗的多囊卵巢综合征的系统评价[J]. 中国生育健康杂志, 2015, 26(4): 298-303.
WU Lianzhi, HE Yi. The effectiveness of metformin and laparoscopic ovarian drilling treatment in women with clomiphene citrate-resistant polycystic ovary syndrome: A systematic review and meta-analysis. Chinese Journal of Reproductive Health, 2015, 26(4): 298-303.
1 Lee da E,Park SY,Park SY,et al.Clinical and Biochemical Profiles according to Homeostasis Model Assessment-insulin Resistance (HOMA-IR) in Korean Women with Polycystic Ovary Syndrome.J Menopausal Med,2014,20:104-110. 2 Norman RJ,Dewailly D,Legro RS,et al.Polycystic ovary syndrome.Lancet,2007,370:685-697. 3 Abu Hashim H,El-Shafei M,Badawy A,et al.Does laparoscopic ovarian diathermy change clomiphene-resistant PCOS into clomiphene-sensitive? Arch Gynecol Obstet,2011,284:503-507. 4 Ayaz A,Alwan Y,Farooq MU.Efficacy of combined metformin-clomiphene citrate in comparison with clomiphene citrate alone in infertile women with polycystic ovarian syndrome (PCOS).J Med Life,2013,6:199-201. 5 Morin-Papunen L,Rantala AS,Unkila-Kallio L,et al.Metformin improves pregnancy and live-birth rates in women with polycystic ovary syndrome (PCOS):a multicenter,double-blind,placebo-controlled randomized trial.J Clin Endocrinol Metab,2012,97:1492-1500. 6 Abu Hashim H,El Lakany N,Sherief L.Combined metformin and clomiphene citrate versus laparoscopic ovarian diathermy for ovulation induction in clomiphene-resistant women with polycystic ovary syndrome:A randomized controlled trial.J Obstet Gynaecol Res,2011,37:169-177. 7 Hamed HO,Hasan AF,Ahmed OG,et al.Metformin versus laparoscopic ovarian drilling in clomiphene- and insulin-resistant women with polycystic ovary syndrome.Int J Gynaecol Obstet,2010,108:143-147. 8 Palomba S,Falbo A,Battista L; et al.Laparoscopic ovarian diathermy vs clomiphene citrate plus metformin as second-line strategy for infertile anovulatory patients with polycystic ovary syndrome:a randomized controlled trial.Am J Obstet Gynecol,2010,202:577,e1-8. 9 Ashrafinia M,Hosseini R,Moini A,et al.Comparison of metformin treatment and laparoscopic ovarian diathermy in patients with polycystic ovary syndrome.Int J Gynaecol Obstet,2009,107:236-239. 10 Palomba S,Orio F Jr,Nardo LG,et al.Metformin administration versus laparoscopic ovarian diathermy clomiphene citrate-resistant women with polycystic ovary syndrome prospective parallel randomized double-blind placebo-controlled trial.J Clin Endocrinol Metab,2004,89:4801-4809. 11 张贤莉.二甲双胍治疗多囊卵巢综合征的临床观察.临床合理用药,2010,3:70-71. 12 Tang T,Lord JM,Norman RJ,et al.Insulin-sensitising drugs(metformin,rosiglitazone,pioglitazone,D-chiro-inosit01)for women with polycystic ovary syndrome,oligo amenorrhoea and subfertility.Cochrane Database Syst Bey,2012,5:CD0003053. 13 Hameed N,Ali MA.Laparoscopic ovarian drilling for polycystic ovarian syndrome:treatment outcome.J Ayub Med Coll Abbottabad,2012,24:90-92.14 Hendriks ML,Ket JC,Hompes PG,et al.Why does ovarian surgery in PCOS help? Insight into the endocrine implications of ovarian surgery for ovulation induction in polycystic ovary syndrome.Hum Reprod update,2007,13:249-264. 15 Amer SA,Laird S,Ledger WL,et al.Effect of laparoscopic ovarian diathermy on circulating inhibin B in women with anovulatory polycystic ovary syndrome.Hum Reprod,2007,22:389-394. 16 Farquhar C,Brown J,Marjoribanks J.Laparoscopic drilling by diathermy or laser for ovulation induction in anovulatory polycystic ovary syndrome.Cochrane Database Syst Rev,2012,6:CD001122.