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. 2007 Jul 18;2007(3):CD000155.
doi: 10.1002/14651858.CD000155.pub2.

Ovulation suppression for endometriosis

E Hughes  1 , J Brown, J J Collins, C Farquhar, D M Fedorkow, P Vandekerckhove
Affiliations

Ovulation suppression for endometriosis

E Hughes et al. Cochrane Database Syst Rev. .

Abstract

Background: Endometriosis is the finding of endometrial glands or stroma in sites other than the uterine cavity. Endometriosis appears to be an oestrogen dependent condition. This hormonal dependency has prompted the therapeutic use of ovulation suppression agents, in an effort to improve subsequent fertility.

Objectives: To assess the effectiveness of ovulation suppression agents, including danazol, progestins and oral contraceptives, in the treatment of endometriosis-associated subfertility in improving pregnancy outcomes including live birth.

Search strategy: We searched the Cochrane Menstrual Disorders and Sub-fertility Group's specialised register of trials (searched October 5th, 2007) the Cochrane Register of Controlled Trials (The Cochrane Library, Issue 3, 2007), MEDLINE (1966-October 2007), EMBASE (1980 - October 2007) and reference lists of articles.

Selection criteria: Randomised trials comparing an ovulation suppression agent with placebo or no treatment, or a suppressive agent with danazol or a GnRH with oral contraception in women with endometriosis. A total of twenty three RCTs comparing an ovulation suppression agent with placebo or no treatment, or a suppressive agent with danazol or a GnRH with oral contraception were identified.

Data collection and analysis: Two review authors independently extracted data and assessed quality. We contacted study authors for additional information. Quality was assessed by of method of randomization,allocation concealment, blinding, completeness of follow-up, presence or absence of crossover and co-intervention. 2 x 2 tables were generated for all relevant outcomes. Odds ratios were generated using the Peto modified Mantel-Haenszel technique. Statistical heterogeneity was assessed using the I(2) test of heterogeneity. Subgroup analysis was conducted on those couples clearly identifiable as infertile or wanting to conceive.

Main results: Twenty four trials were included. The odds ratio for pregnancy following ovulation suppression versus placebo or no treatment for all women randomised was 0.79 (95% CI 0.54 to 1.14), P = 0.21 and 0.80 (95% CI 0.51 to 1.24), P = 0.32 respectively for subfertile couples only despite the use of a variety of suppression agents. There was no evidence of benefit from the treatment. The common odds ratio for pregnancy following all agents versus danazol for all women randomised was 1.38 (95% CI 1.05 to 1.82), P = 0.02 and OR 1.37 (95% CI 0.94 to 1.99), P = 0.10 for subfertile couples only. When GnRHa and danazol were directly compared, OR was 1.45 (95% CI 1.08 to 1.95) P = 0.01 for all women randomised and OR 1.63( 95% CI 1.12 to 2.37), P = 0.01 for subfertile couples only in favour of GnRH. No effect was observed for GnRH compared with oral contraception; OR 0.99 (95% CI 0.52 to 1.89), P = 0.98 for all women randomised and OR 0.79 ( 95% CI 0.37 to 1.69), P = 0.55. In all analyses the data were statistically homogeneous (I(2)=0%).

Authors' conclusions: There is no evidence of benefit in the use of ovulation suppression in subfertile women with endometriosis who wish to conceive.

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Conflict of interest statement

None known

Figures

1
1
Methodological quality summary: review authors' judgements about each methodological quality item for each included study
2
2
Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies
3
3
Funnel plot of comparison: 1 Ovulation suppression versus placebo or no treatment, outcome: 1.1 Clinical pregnancy
4
4
Funnel plot of comparison: 2 Other ovulation suppression agents versus danazol, outcome: 2.2 Clinical pregnancy
5
5
Funnel plot of comparison: 3 GnRHa versus danazol, outcome: 3.1 Clinical pregnancy
6
6
Funnel plot of comparison: 4 GnRH versus oral contraception, outcome: 4.2 Clinical pregnancies
1.1
1.1. Analysis
Comparison 1 Ovulation suppression versus placebo, Outcome 1 Clinical pregnancy.
1.2
1.2. Analysis
Comparison 1 Ovulation suppression versus placebo, Outcome 2 Clinical pregnancy ‐ Ovulation agents other than Danazol vs placebo/no treatment.
2.1
2.1. Analysis
Comparison 2 Other ovulation suppression agents versus danazol, Outcome 1 Live birth.
2.2
2.2. Analysis
Comparison 2 Other ovulation suppression agents versus danazol, Outcome 2 Clinical Pregnancy.
3.1
3.1. Analysis
Comparison 3 GnRHa versus danazol, Outcome 1 Clinical Pregnancy.
4.1
4.1. Analysis
Comparison 4 GnRH versus oral contraception, Outcome 1 Live births.
4.2
4.2. Analysis
Comparison 4 GnRH versus oral contraception, Outcome 2 Clinical pregnancies.
See this image and copyright information in PMC

Update of

References

References to studies included in this review

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Bergquist 1990 {published data only}
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Biberoglu 1981 {published data only}
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References to other published versions of this review

Hughes 2003
    1. Hughes E, Fedorkow D, Collins J, Vandekerckhove P. Ovulation suppression for endometriosis. Cochrane Database of Systematic Reviews 2003, Issue 3. [DOI: 10.1002/14651858] - DOI - PubMed

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