{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T06:29:19Z","timestamp":1790922559905,"version":"4.1.0"},"reference-count":108,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2016,10,27]],"date-time":"2016-10-27T00:00:00Z","timestamp":1477526400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"Marietta Blau Grant"},{"name":"Austrian Agency for International Cooperation in Education and Research"},{"DOI":"10.13039\/501100010109","name":"Medical University of Graz","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100010109","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet & Gyne"],"published-print":{"date-parts":[[2016,12]]},"abstract":"ABSTRACT<\/jats:title>Objectives<\/jats:title>To identify, appraise and summarize the current evidence regarding the efficacy of strategies aimed at improving assisted reproductive techniques in women with polycystic ovary syndrome (PCOS<\/jats:styled-content>).<\/jats:p><\/jats:sec>Methods<\/jats:title>A comprehensive literature search of the standard medical databases was performed. The last electronic search was run in July 2015. The primary outcome measures were live birth\/ongoing pregnancy and ovarian hyperstimulation syndrome (OHSS<\/jats:styled-content>). The secondary outcome measures were clinical pregnancy and miscarriage.<\/jats:p><\/jats:sec>Results<\/jats:title>We screened 1021 records and completely assessed 173, finally including 66 studies in the quantitative analysis. Many different interventions were assessed, however the overall quality of the studies was low. We observed moderate\u2010quality evidence that there is no clinically relevant difference in live birth\/ongoing pregnancy rates (relative risk (RR<\/jats:styled-content>), 0.95 (95%\u2009CI<\/jats:styled-content>, 0.84\u20131.08)), or clinical pregnancy (RR<\/jats:styled-content>, 1.02 (95%\u2009CI<\/jats:styled-content>, 0.91\u20131.15)) when comparing antagonist and agonist protocols for ovarian stimulation. Additionally, we found low\u2010quality evidence that metformin improves live birth\/ongoing pregnancy (RR<\/jats:styled-content>, 1.28 (95%\u2009CI<\/jats:styled-content>, 1.01\u20131.63)) and clinical pregnancy rates (RR<\/jats:styled-content>, 1.26 (95%\u2009CI<\/jats:styled-content>, 1.04\u20131.53)) when compared with placebo or no intervention. We further found low\u2010quality evidence that there is no clinically relevant difference in live birth\/ongoing pregnancy rates (RR<\/jats:styled-content>, 1.03 (95%\u2009CI<\/jats:styled-content>, 0.80\u20131.34)) and clinical pregnancy rates (RR<\/jats:styled-content>, 0.99 (95%\u2009CI<\/jats:styled-content>, 0.81\u20131.22)) when comparing human menopausal gonadotropin for inducing ovulation and artificial preparation with estradiol valerate for endometrial preparation for frozen embryo transfer (FET<\/jats:styled-content>). Low\u2010quality evidence suggests that mannitol compared with no intervention (RR<\/jats:styled-content>, 0.54 (95%\u2009CI<\/jats:styled-content>, 0.39\u20130.77)) and antagonist protocols compared with agonist protocols (RR<\/jats:styled-content>, 0.63 (95%\u2009CI<\/jats:styled-content>, 0.49\u20130.80)) reduce rates of OHSS<\/jats:styled-content>.<\/jats:p><\/jats:sec>Conclusion<\/jats:title>There is low\u2010 to moderate\u2010quality evidence suggesting that antagonist protocols are preferable to agonist ones, because they reduce the incidence of OHSS<\/jats:styled-content> without interfering with clinical pregnancy and live birth for women with PCOS<\/jats:styled-content>. Additionally there is low\u2010quality evidence pointing to a benefit of metformin supplementation on clinical pregnancy and live birth; and that ovulation induction and administration of estradiol seem to be equally effective for endometrial preparation before FET<\/jats:styled-content> for women with PCOS<\/jats:styled-content>. For all other interventions, the evidence is of very low quality, not allowing any meaningful conclusions to be drawn.<\/jats:p><\/jats:sec>Estrategias para mejorar el resultado de la reproducci\u00f3n asistida en mujeres con s\u00edndrome de ovario poliqu\u00edstico: revisi\u00f3n sistem\u00e1tica y metaan\u00e1lisis<\/jats:bold><\/jats:p>RESUMEN<\/jats:bold><\/jats:p><\/jats:sec>Objetivos<\/jats:title>Identificar, evaluar y resumir la evidencia actual sobre la eficacia de las estrategias para mejorar las t\u00e9cnicas de reproducci\u00f3n asistida en mujeres con s\u00edndrome de ovario poliqu\u00edstico (SOP<\/jats:styled-content>).<\/jats:p><\/jats:sec>M\u00e9todos<\/jats:title>Se realiz\u00f3 una b\u00fasqueda exhaustiva de literatura en las bases de datos m\u00e9dicas est\u00e1ndar. La \u00faltima b\u00fasqueda electr\u00f3nica se realiz\u00f3 en julio de 2015. Las medidas de resultado primarias fueron los nacimientos vivos\/embarazos en curso y el s\u00edndrome de hiperestimulaci\u00f3n ov\u00e1rica (SHO<\/jats:styled-content>). Las medidas de resultado secundarias fueron el embarazo confirmado ecogr\u00e1ficamente y el aborto.<\/jats:p><\/jats:sec>Resultados<\/jats:title>Se cribaron 1021 registros, de los que se evaluaron por completo 173, para finalmente incluir 66 estudios en el an\u00e1lisis cuantitativo. Aunque se evaluaron muchas intervenciones diferentes, en general la calidad de los estudios fue baja. Se observ\u00f3 evidencia de calidad moderada de que no hay diferencias relevantes cl\u00ednicamente en las tasas de nacimientos vivos\/embarazos en curso (riesgo relativo (RR<\/jats:styled-content>): 0,95 (IC<\/jats:styled-content> 95%, 0,84\u20131,08)), o de embarazos confirmados ecogr\u00e1ficamente (RR<\/jats:styled-content>: 1,02 (IC<\/jats:styled-content> 95%, 0,91\u20131,15)), cuando se comparan los protocolos de antagonistas y agonistas para la estimulaci\u00f3n ov\u00e1rica. Adem\u00e1s, se encontr\u00f3 evidencia de baja calidad en que la metformina mejora las tasas de nacimientos vivos\/embarazos en curso (RR<\/jats:styled-content>: 1,28 (IC<\/jats:styled-content> 95%, 1,01\u20131,63)) y de embarazos confirmados ecogr\u00e1ficamente (RR<\/jats:styled-content>: 1,26 (IC<\/jats:styled-content> 95%, 1,04\u20131,53)) en comparaci\u00f3n con un placebo o la no intervenci\u00f3n. Se encontr\u00f3 tambi\u00e9n evidencia de baja calidad en que no hay diferencias relevantes cl\u00ednicamente en las tasas de nacimientos vivos\/embarazos en curso (RR<\/jats:styled-content>: 1,03 (IC<\/jats:styled-content> 95%, 0,80\u20131,34)) y las tasas de embarazos confirmados ecogr\u00e1ficamente (RR<\/jats:styled-content>: 0,99 (IC<\/jats:styled-content> 95%, 0.81\u20131,22)) al comparar la gonadotropina menop\u00e1usica humana para la inducci\u00f3n de la ovulaci\u00f3n y la preparaci\u00f3n artificial con el valerato de estradiol para preparar el endometrio para la transferencia de embriones congelados (TEC<\/jats:styled-content>). La baja calidad de la evidencia sugiere que el manitol, en comparaci\u00f3n con la no intervenci\u00f3n (RR<\/jats:styled-content>: 0,54 (IC<\/jats:styled-content> 95%, 0,39\u20130,77)), y los protocolos de antagonistas, en comparaci\u00f3n con los protocolos de agonistas (RR<\/jats:styled-content>: 0,63 (IC<\/jats:styled-content> 95%, 0,49\u20130,80)), reducen las tasas de SHO<\/jats:styled-content>.<\/jats:p><\/jats:sec>Conclusi\u00f3n<\/jats:title>Hay evidencia de calidad baja a moderada que sugiere que los protocolos de antagonistas son preferibles a los de agonistas, ya que reducen la tasa de SHO<\/jats:styled-content> sin interferir con el embarazo confirmado ecogr\u00e1ficamente y los nacimientos vivos en las mujeres con SOP<\/jats:styled-content>. Adem\u00e1s, existe evidencia de baja calidad que indica un beneficio del uso de metformina como aporte suplementario en embarazos confirmados ecogr\u00e1ficamente y en nacimientos vivos; y que la inducci\u00f3n de la ovulaci\u00f3n y la administraci\u00f3n de estradiol parecen ser igualmente eficaces para la preparaci\u00f3n del endometrio antes de la TEC<\/jats:styled-content> en mujeres con SOP<\/jats:styled-content>. Para el resto de procedimientos, la evidencia es de muy baja calidad, y por ello no permite extraer conclusiones importantes.<\/jats:p><\/jats:sec>image<\/jats:alt-text><\/jats:graphic><\/jats:boxed-text>\n<\/jats:p><\/jats:sec>","DOI":"10.1002\/uog.15898","type":"journal-article","created":{"date-parts":[[2016,2,29]],"date-time":"2016-02-29T05:17:15Z","timestamp":1456723035000},"page":"709-718","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":51,"title":["Strategies for improving outcome of assisted reproduction in women with polycystic ovary syndrome: systematic review and meta\u2010analysis"],"prefix":"10.1002","volume":"48","author":[{"given":"M.","family":"Kollmann","sequence":"first","affiliation":[{"name":"Division of Obstetrics and Maternal Fetal Medicine, Department of Obstetrics and Gynecology Medical University of Graz Graz Austria"},{"name":"Division of Child Health, Obstetrics & Gynaecology, School of Medicine University of Nottingham Nottingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"W. 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