Evidence for treatment strategies in PCOS

Infertility affects about one in seven of all couples that are trying to conceive. This thesis focused on WHO type II ovulation disorder, which concerns the majority of women with ovulation disorders. WHO type II ovulation disorder results from absent or irregular ovulation due to hypothalamic-pituitary-ovarian dysfunction and is also known as normogonadotropic anovulation. If women with normogonadotropic anovulation wish to conceive, strategies to induce ovulation include treatment with clomiphene citrate (CC), letrozole, gonadotrophins, and CC with metformin. Also, intrauterine insemination (IUI) can be added to replace intercourse. CC and gonadotrophins are both well established and effective treatment options and have been used for many years. Currently, letrozole is known to be more effective, but the use of letrozole is in many countries off-label for this indication. Individual participant data (IPD) can combine evidence of multiple comparisons and they have the power to evaluate effectiveness and safety of interventions within subgroups. As women with PCOS represent a heterogeneous population according to the diagnostic criteria, it is important to identify which individuals benefit most from a particular treatment so that clinicians can provide personalized care. Also, the availability of IPD and the willingness to share data may be an indicator of quality, methodological soundness and integrity of trials when they are being considered for inclusion in systematic reviews. Integrity problems in scientific research often occurs. About 2% of scientists admitted to having fabricated, falsified, or modified data or results at least once and on average over 14% of scientists observed these behaviors among their colleagues. In this thesis we evaluated the effectiveness, safety, costs and long-term results of the different treatment options in women with normogonadotropic anovulation. Secondly, we evaluated the quality of shared and non-shared RCT’s and give an overview of the available methods to investigate ...