Chinese herbal medicine for subfertile women with polycystic ovarian syndrome.
BACKGROUND
Polycystic ovarian syndrome (PCOS) is one of the most common reproductive endocrinology abnormalities, affecting 5% to 10% of women of reproductive age. Western medicines, such as oral contraceptives and insulin sensitizers, have been widely used to improve the symptoms and signs for PCOS. Recently, many studies have been published considering Chinese herbal medicine (CHM) as an alternative treatment for women with PCOS.


OBJECTIVES
To evaluate the efficacy and safety of Chinese medicinal herbs for subfertile women with PCOS.


SEARCH STRATEGY
We searched the following databases (from inception to March 2010): Menstrual Disorders and Subfertility Group Specialised Register (MDSG), Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, Allied and Complementary Medicine (AMED), PsycINFO, Chinese National Knowledge Infrastructure (CNKI), VIP, Wanfang. In addition, all reference lists of included trials were searched and experts in the field were contacted to locate trials.


SELECTION CRITERIA
Randomized controlled trials (RCT) considering 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 methodological quality, and extracted data. We contacted primary authors for additional information. Meta-analysis was conducted. Odds ratio (OR) was used for reporting dichotomous data with 95% confidence intervals (CI).


MAIN RESULTS
Four RCTs involving 344 participants were included. The methodological risk of bias of included studies was poor. Different interventions were used in these four RCTs.There was evidence of statistically significant difference seen improving pregnancy rate (per woman) between CHM plus clomiphene and clomiphene (OR 2.97, 95%CI 1.71 to 5.17). However, there was no statistically significant difference seen in the other comparison groups for improving pregnancy rate (per woman).There was no evidence of statistically significant difference in improving ovulation rate (per woman) between CHM and clomiphene (OR 1.42, 95%CI 0.19 to 10.49), between CHM plus laparoscopic ovarian drilling (LOD) and LOD (OR 2.43, 95%CI 0.39 to 15.08).There were not statistically significant difference between CHM plus follicle aspiration, ovulation induction and follicle aspiration plus ovulation induction for adverse events including LUFS, OHSS and multiple pregnancy.Live birth rate was not reported by any studies.


AUTHORS' CONCLUSIONS
There is limited evidence that the addition of CHM to clomiphene is associated with improved clinical pregnancy outcomes and no other evidence of any other effect. The methodology of RCTs was not adequately reported by primary studies.