Wang Rui, Kim Bobae V, van Wely Madelon, Johnson Neil P, Costello Michael F, Zhang Hanwang, Ng Ernest Hung Yu, Legro Richard S, Bhattacharya Siladitya, Norman Robert J, Mol Ben Willem J
Robinson Research Institute, Discipline of Obstetrics and Gynaecology, School of Medicine, University of Adelaide, North Adelaide, Australia
Reproductive Medicine Centre, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
BMJ. 2017 Jan 31;356:j138. doi: 10.1136/bmj.j138.
To compare the effectiveness of alternative first line treatment options for women with WHO group II anovulation wishing to conceive.
Systematic review and network meta-analysis.
Cochrane Central Register of Controlled Trials, Medline, and Embase, up to 11 April 2016.
Randomised controlled trials comparing eight ovulation induction treatments in women with WHO group II anovulation: clomiphene, letrozole, metformin, clomiphene and metformin combined, tamoxifen, gonadotropins, laparoscopic ovarian drilling, and placebo or no treatment. Study quality was measured on the basis of the methodology and categories described in the Cochrane Collaboration Handbook. Pregnancy, defined preferably as clinical pregnancy, was the primary outcome; live birth, ovulation, miscarriage, and multiple pregnancy were secondary outcomes.
Of 2631 titles and abstracts initially identified, 54 trials reporting on 7173 women were included. All pharmacological treatments were superior to placebo or no intervention in terms of pregnancy and ovulation. Compared with clomiphene alone, both letrozole and the combination of clomiphene and metformin showed higher pregnancy rates (odds ratio 1.69, 95% confidence interval 1.33 to 2.14; 1.71, 1.28 to 2.27; respectively). Letrozole led to higher live birth rates when compared with clomiphene alone (1.67, 1.11 to 2.49). Metformin led to lower multiple pregnancy rates compared with clomiphene alone (0.22, 0.05 to 0.93).
In women with WHO group II anovulation, letrozole and the combination of clomiphene and metformin are superior to clomiphene alone in terms of pregnancy. Compared with clomiphene alone, letrozole is the only treatment showing a significantly higher rate of live birth.
PROSPERO CRD42015027579.
READERS' NOTE: This is the second version of this paper. The original version was corrected following the retraction of two studies and removal of another which were ineligible (references 40, 41, and 75 of the original paper). These studies are not shown in this version. A tracked changes version of the original version is attached as a supplementary file to the correction notice, which explains the issue further.
比较多种一线治疗方案对希望受孕的世界卫生组织（WHO）II 型无排卵女性的有效性。
系统评价和网状 Meta 分析。
截至 2016 年 4 月 11 日的考克兰系统评价数据库、医学期刊数据库（Medline）和荷兰医学文摘数据库（Embase）。
比较 WHO II 型无排卵女性的八种促排卵治疗方法的随机对照试验：克罗米芬、来曲唑、二甲双胍、克罗米芬与二甲双胍联合使用、他莫昔芬、促性腺激素、腹腔镜卵巢打孔术，以及安慰剂或不治疗。根据考克兰协作手册中描述的方法和类别来衡量研究质量。妊娠（最好定义为临床妊娠）是主要结局；活产、排卵、流产和多胎妊娠是次要结局。
在最初识别的 2631 篇标题和摘要中，纳入了 54 项涉及 7173 名女性的试验。在妊娠和排卵方面，所有药物治疗均优于安慰剂或不干预。与单独使用克罗米芬相比，来曲唑以及克罗米芬与二甲双胍联合使用均显示出更高的妊娠率（优势比分别为 1.69，95%置信区间 1.33 至 2.14；1.71，1.28 至 2.27）。与单独使用克罗米芬相比，来曲唑导致更高的活产率（1.67，1.11 至 2.49）。与单独使用克罗米芬相比，二甲双胍导致更低的多胎妊娠率（0.22，0.05 至 0.93）。
对于 WHO II 型无排卵女性，就妊娠而言，来曲唑以及克罗米芬与二甲双胍联合使用优于单独使用克罗米芬。与单独使用克罗米芬相比，来曲唑是唯一显示活产率显著更高的治疗方法。
PROSPERO CRD42015027579。
这是本文的第二版。原始版本在两项研究撤回以及另一项不符合条件的研究（原始论文的参考文献 40、41 和 75）被剔除后进行了修正。此版本未显示这些研究。原始版本的修订跟踪版本作为补充文件附在勘误通知中，对该问题进行了进一步解释。
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