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Evidence-based reproductive medicine in clinical practice: the case of clomiphene-resistant PCOS

  • Clinical Review
  • Published:
European Clinics in Obstetrics and Gynaecology

Abstract

Evidence-based medicine (EBM) tries to integrate best research evidence with clinical expertise and patient values. Clinicians can use this method to provide their counseled patients with the best available evidence. The aim of the present article is to demonstrate the application of EBM in everyday practice. We present a case of a woman with subfertility due to polycystic ovary syndrome (PCOS) who was not responding to treatment with clomiphene citrate. Herein a search of the literature is discussed, and a randomised clinical trial assessing the effectiveness of a strategy starting with laparoscopic electrocoagulation (LEO) and gonadotrophins is scrutinised with regard to internal validity. Studies on treatment should be appraised regarding method randomisation, concealment of allocation, blinding or masking, comparability of the groups, completeness of follow-up, analysis according to the intention-to-treat principle, equality of treatment of both groups, and adequate sample size. The study reports both treatments to be equally effective with respect to ongoing pregnancy, which is the primary outcome. A strategy starting with LEO seems to be more cost-effective and reduces the number of multiple pregnancies, which are arguments in favour of it. These arguments should be weighed against individual characteristics such as the risk of laparoscopic surgery and individual patient preferences.

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References

  1. Davidoff F, Haynes B, Sackett D, Smith R (1995) Evidence based medicine: a new journal to help doctors identify the information they need. BMJ 310:1085–1086

    Google Scholar 

  2. Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Richardson WS (1996) Evidence based medicine, what it is and what it isn’t. BMJ 312:71–72

    Google Scholar 

  3. Guyatt G, Drummond R (2002) Users’ guides to the medical literature: a manual for evidence-based clinical practice. AMA Press, Chicago

  4. Sackett DL, Straus SE, Richardson WS, Rosenberg W, Haynes RB (2000) Evidence-based medicine: how to practice and teach EBM. Churchill Livingstone, New York

    Google Scholar 

  5. Coomarasamy A, Khan KS (2004) What is the evidence that postgraduate teaching in EBM changes anything? A systematic review. BMJ 329:1017

    Google Scholar 

  6. Stein IF, Leventhal ML (1935) Amenorrhea associated with bilateral polycystic ovaries. Am J Obstet Gynecol 29:181–191

    Google Scholar 

  7. Hull MG, Glazener CM, Kelly NJ, Conway DI, Foster PA, Hinton RA, Coulson C, Lambert PA, Watt EM, Desai KM (1985) Population study of causes, treatment, and outcome of infertility. BMJ 291:1693–1697

    Google Scholar 

  8. Rowe PJ, Comhaire FH, Hargreave TB, Mellows HJ (1993) WHO manual for the standardized investigation and diagnosis of the infertile couple. Cambridge University Press, Cambridge

    Google Scholar 

  9. Imani B, Eijkemans MJ, te Velde ER, Habbema JD, Fauser BC (1998) Predictors of patients remaining anovulatory during clomiphene citrate induction of ovulation in normogonadotropic oligoamenorrheic infertility. J Clin Endocrinol Metab 83:2361–2365

    Article  CAS  Google Scholar 

  10. Imani B, Eijkemans MJ, te Velde ER, Habbema JD, Fauser BC (1999) Predictors of chances to conceive in ovulatory patients during clomiphene citrate induction of ovulation in normogonadotropic oligoamenorrheic infertility. J Clin Endocrinol Metab 84:1617–1622

    CAS  PubMed  Google Scholar 

  11. Gjonnaess H (1984) Polycystic ovarian syndrome treated by ovarian electrocautery through the laparoscope. Fertil Steril 41:20–25

    CAS  Google Scholar 

  12. Khan JD, Kunz R, Antes G, Kleijnen J (2003) Framing questions for a review. In: Systematic reviews to support evidence-based medicine. How to review and apply findings of healthcare literature. Royal Society of Medicine Press, London

  13. Palomba S, Orio F Jr, Nardo LG, Falbo A, Russo T, Corea D, Doldo P, Lombardi G, Tolino A, Colao A, Zullo F (2004) Metformin administration versus laparoscopic ovarian diathermy in clomiphene citrate-resistant women with polycystic ovary syndrome: a prospective parallel randomised double-blind placebo-controlled trial. J Clin Endocrinol Metab 89:4801–4809

    Article  CAS  Google Scholar 

  14. Bayram N, van Wely M, Kaaijk EM, Bossuyt PM, van der Veen F (2004) Using an electrocautery strategy or recombinant follicle stimulating hormone to induce ovulation in polycystic ovary syndrome: randomised controlled trial. BMJ 328:192

    Google Scholar 

  15. Schulz KF, Chalmers I, Hayes RJ, Altman DG (1995) Empirical evidence of bias. Dimensions of methodological quality associated with estimates of treatment effects in controlled trials. JAMA 273:408–412

    CAS  PubMed  Google Scholar 

  16. Moher D, Pham B, Jones A et al (1998) Does quality of reports of randomised trials affect estimates of intervention efficacy reported in meta-analyses? Lancet 352:609–613

    Article  CAS  Google Scholar 

  17. Grimes DA, Schulz KF (1996) Determining sample size and power in clinical trials: the forgotten essential. Semin Reprod Endocrinol 14:125–131

    CAS  Google Scholar 

  18. van Wely M, Bayram N, van der Veen F, Bossuyt PM (2004) Laparoscopic electrocautery of the ovaries versus recombinant FSH in clomiphene citrate-resistant polycystic ovary syndrome. Impact on women’s health-related quality of life. Hum Reprod 19:2244–2250

    Article  Google Scholar 

  19. van Wely M, Bayram N, van der Veen F, Bossuyt PM (2004) An economic comparison of a laparoscopic electrocautery strategy and ovulation induction with recombinant FSH in women with clomiphene citrate-resistant polycystic ovary syndrome. Hum Reprod 19:1741–1745

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Obstetrics and Gynaecology, Máxima Medical Centre Veldhoven, P.O. Box 7777, 5500, DB, Veldhoven, The Netherlands

    Elisabeth A. A. van Tetering & Ben W. J. Mol

  2. TweeSteden Hospital Tilburg, Dr Deelenlaan 5, 5042, AD, Tilburg, The Netherlands

    Hendricus J. H. M. van Dessel

Authors
  1. Elisabeth A. A. van Tetering
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  2. Hendricus J. H. M. van Dessel
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  3. Ben W. J. Mol
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Correspondence to Elisabeth A. A. van Tetering.

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van Tetering, E.A.A., van Dessel, H.J.H.M. & Mol, B.W.J. Evidence-based reproductive medicine in clinical practice: the case of clomiphene-resistant PCOS. Eur Clinics Obstet Gynaecol 1, 89–94 (2005). https://doi.org/10.1007/s11296-005-0014-5

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  • DOI: https://doi.org/10.1007/s11296-005-0014-5

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