Chinese herbal medicine for subfertile women with polycystic ovarian syndrome
Chinese herbal medicine for subfertile women with polycystic ovarian syndrome.
- 1Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.
Abstract
BACKGROUND:
Polycystic ovarian syndrome (PCOS)
is one of the most common reproductive endocrinology abnormalities, and
affects 5% to 10% of women of reproductive age. Western medicines, such
as oral contraceptives, insulin sensitizers and laparoscopic ovarian
drilling (LOD), have been used to treat PCOS. Recently, many studies have been published that consider Chinese herbal medicine (CHM) as an alternative treatment for women with PCOS.
OBJECTIVES:
To assess the efficacy and safety of CHM for subfertile women with PCOS.
SEARCH METHODS:
We
searched sources, including the following databases, from inception to 9
June 2016: the Cochrane Gynaecology and Fertility Group Specialized
Register, the Cochrane Central Register of Controlled Trials (CENTRAL),
MEDLINE, EMBASE, Allied and Complementary Medicine (AMED), PsycINFO,
Chinese National Knowledge Infrastructure (CNKI), VIP, Wanfang and trial
registries. In addition, we searched the reference lists of included
trials and contacted experts in the field to locate trials.
SELECTION CRITERIA:
Randomized controlled trials (RCTs) that considered the use of CHM for the treatment of subfertile women with PCOS.
DATA COLLECTION AND ANALYSIS:
Two
review authors independently screened appropriate trials for inclusion,
assessed the risk of bias in included studies and extracted data. We
contacted primary study authors for additional information. We conducted
meta-analyses. We used the odds ratios (ORs) to report dichotomous
data, with 95% confidence intervals (CI). We assessed the quality of the
evidence using the Grading of Recommendations Assessment, Development
and Evaluation (GRADE) methods.
MAIN RESULTS:
We
included five RCTs with 414 participants. The comparisons in the
included trials were as follows: CHM versus clomiphene, CHM plus
clomiphene versus clomiphene (with or without ethinyloestradiol
cyproterone acetate (CEA)), CHM plus follicle aspiration plus ovulation
induction versus follicle aspiration plus ovulation induction alone, and
CHM plus laparoscopic ovarian drilling (LOD) versus LOD alone. The
overall quality of the evidence for most comparisons was very low.None
of the included studies reported live birth rate, and only one study
reported data on adverse events.When CHM was compared with clomiphene
(with or without LOD in both arms), there was no evidence of a
difference between the groups in pregnancy rates (odds ratio (OR) 1.98,
95% confidence interval (CI) 0.78 to 5.06; two studies, 90 participants,
I² statistic = 0%, very low quality evidence). No study reported data
on adverse events. When CHM plus clomiphene was compared with clomiphene
(with or without CEA), there was low quality evidence of a higher
pregnancy rate in the CHM plus clomiphene group (OR 2.62, 95% CI 1.65 to
4.14; three RCTs, 300 women, I² statistic = 0%,low quality evidence).
No data were reported on adverse events.When CHM with follicle
aspiration and ovulation induction was compared with follicle aspiration
and ovulation induction alone, there was no evidence of a difference
between the groups in pregnancy rates (OR 1.60, 95% CI 0.46 to 5.52; one
study, 44 women, very low quality evidence), severe luteinized
unruptured follicle syndrome (LUFS) (OR 0.60, 95% CI 0.06 to 6.14; one
study, 44 women, very low quality evidence), ovarian hyperstimulation
syndrome (OHSS) (OR 0.16, 95% CI 0.00 to 8.19; one study, 44 women, very
low quality evidence) or multiple pregnancy (OR 0.60, 95% CI 0.06 to
6.14; one study, 44 women, very low quality evidence).When CHM with LOD
was compared with LOD alone, there was no evidence of a difference
between the groups in rates of pregnancy (OR 3.50, 95% CI 0.72 to 17.09;
one study, 30 women, very low quality evidence), No data were reported
on adverse events.There was no evidence of a difference between any of
the comparison groups for any other outcomes. The quality of the
evidence for all other comparisons and outcomes was very low. The main
limitations in the evidence were failure to report live birth or adverse
events, failure to describe study methods in adequate detail and
imprecision due to very low event rates and wide CIs.
AUTHORS' CONCLUSIONS:
There is insufficient evidence to support the use of CHM for women with PCOS
and subfertility. No data are available on live birth, and there is no
consistent evidence to indicate that CHM influences fertility outcomes.
However there is very limited low quality evidence to suggest that the
addition of CHM to clomiphene may improve pregnancy rates. There is
insufficient evidence on adverse effects to indicate whether CHM is
safe.
