A Cochrane review [Abstract] 1 [withdrawn from publication] on the effectiveness of urinary-derived gonadotrophins as ovulation induction agents in patients with PCOS trying to conceive included 14 RCTs. Few dealt with the same comparisons, and all were small to moderate size and their methodological quality was generally poor. In one of the comparisons there was a significant improvement in pregnancy rate, but this may be due to the lack of power. There was a trend towards better pregnancy rates with the addition of a GnRH analogue to gonadotrophin stimulation and these interventions warrant further study.
Despite theoretical advantages, urinary-derived FSH preparations did not improve pregnancy rates when compared to traditional and cheaper hMG preparations (human menopausal gonadotrophin containing both FSH and LH); their only demonstrable benefit was a reduced risk of ovarian hyperstimulation syndrome (OHSS) in cycles when administered without the concomitant use of a GnRH-a. Meta-analysis revealed a reduction in the incidence of OHSS with FSH compared to hMG in stimulation cycles without the concomitant use of a GnRH-a (OR 0.20; 95% CI 0.08-0.46) and a higher overstimulation rate when a GnRH-a is added to gonadotrophins (OR 3.15; 95% CI 1.48-6.70).
No conclusions can be drawn on miscarriage and multiple pregnancy rates due to insufficient reporting of these outcomes in the trials.
Comment: The quality of evidence is downgraded by study limitations and heterogeneity of interventions
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