Interventions for endometriosis-related infertility: a systematic review and network meta-analysis

Abstract

OBJECTIVE: To compare the effectiveness of different treatments for women with endometriosis-related infertility. DESIGN: A systematic review and network meta-analysis of randomized controlled trials (RCTs). SETTING: Not applicable. PATIENT(S): Women with endometriosis confirmed by laparoscopy with associated infertility. INTERVENTION(S): An extensive electronic search of the following databases: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, ClinicalTrials.gov, and Embase. MAIN OUTCOME MEASURE(S): Clinical pregnancy, live birth rate, miscarriage, and adverse events. RESULT(S): A total of 4,252 trials/abstracts were identified through the literature search, of which we included 36 trials in the systematic review and 26 trials reporting on 2,245 women with endometriosis-related infertility in the network meta-analysis. Network meta-analysis showed that compared with placebo, surgical laparoscopy alone (odds ratio = 1.63; 95% confidence interval, 1.13-2.35) or GnRH agonist alone (odds ratio = 1.68; 95% confidence interval, 1.07-2.46) results in higher odds of pregnancy. The evidence on the other interventions versus placebo or on the secondary outcomes including live birth, miscarriage, and adverse events is insufficient. CONCLUSION(S): The most important conclusion is that more RCTs are needed to clarify the relative effectiveness of treatments for endometriosis-related infertility, ideally comparing interventions to existing recommended interventions such as surgical laparoscopy. In addition, further RCTs comparing IVF and IUI to other treatments are essential. REGISTRATION NUMBER: PROSPERO registration number, CRD42018087572.