Current Issue

Volume 13, Number 4, Jan-Mar 2020 Pages: 257-270

Medical and Surgical Treatment of Reproductive Outcomes in Polycystic Ovary Syndrome: An Overview of Systematic Reviews

Moustafa A. Gadalla, M.Sc, 1, 2, *, Robert J. Norman, M.D., FRANZCOG, 2, Chau T Tay, Ph.D, 3, 4, Danielle S. Hiam, Ph.D, 5, Angela Melder, Ph.D, 3, Jyotsna Pundir, M.D., Ph.D, 6, Shakila Thangaratinam, Ph.D, 7, Helena J Teede, Ph.D, 3, 4, Ben W. J. Mol, M.D., Ph.D, 2, 8, Lisa J. Moran, Ph.D, 2, 3,
Women’s Health Hospital, Department of Obstetrics and Gynaecology, Assiut University, Assiut, Egypt
Robinson Research Institute, Discipline of Obstetrics and Gynaecology, University of Adelaide, Adelaide, Australia
Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Victoria, Melbourne, Australia
Monash Diabetes and Endocrinology Units, Monash Health, Victoria, Melbourne, Australia
Institute of Sport, Exercise and Active Living, Victoria University, Melbourne, Australia
Centre of Reproductive Medicine, St Bartholomew’s Hospital, London, United Kingdom
Women’s Health Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University London, London, United Kingdom
Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Melbourne, Australia
*Corresponding Address: Women’s Health Hospital Department of Obstetrics and Gynaecology Assiut University Assiut Egypt


Polycystic ovary syndrome (PCOS) is a common, complex condition that affects up to 18% of reproductive- aged women, causing reproductive, metabolic and psychological dysfunctions. We performed an overview and appraisal of methodological quality of systematic reviews that assessed medical and surgical treatments for reproductive outcomes in women with PCOS. Databases (MEDLINE, EMBASE, CINAHL PLUS and PROSPERO) were searched on the 15th of September 2017. We included any systematic review that assessed the effect of medical or surgical management of PCOS on reproductive, pregnancy and neonatal outcomes. Eligibility assessment, data extraction and quality assessment by the Assessing the Methodological Quality of Systematic Reviews (AMSTAR) tool were performed in duplicate. We identified 53 reviews comprising 44 reviews included in this overview; the majority were moderate to high quality. In unselected women with PCOS, letrozole was associated with a higher live birth rate than clomiphene citrate (CC), while CC was better than metformin or placebo. In women with CC-resistant PCOS, gonadotrophins were associated with a higher live birth rate than CC plus metformin, which was better than laparoscopic ovarian drilling (LOD). LOD was associated with lower multiple pregnancy rates than other medical treatments. In women with PCOS undergo- ing in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI), the addition of metformin to gonadotro- phins resulted in less ovarian hyperstimulation syndrome (OHSS), and higher pregnancy and live birth rates than gonadotrophins alone. Gonadotrophin releasing hormone (GnRH) antagonist was associated with less OHSS, gonadotrophin units and shorter stimulation length than GnRH agonist. Letrozole appears to be a good first line treatment and gonadotrophins, as a second line treatment, for anovulatory women with PCOS. LOD results in lower multiple pregnancy rates. However, due to the heterogeneous nature of the included popula- tions of women with PCOS, further larger scale trials are needed with more precise assessment of treatments according to heterogeneous variants of PCOS.