Assisted reproductive medicine: Systematic reviews and randomized controlled trials

Abstract

The objective for this thesis was to propose a question in the area of reproductive medicine that could be addressed by a clinical trial. In preparation for such a trial we conducted a systematic review of the topic. Our first question was whether metformin is of benefit compared to clomiphene citrate for ovulation induction and achievement of pregnancy in women with polycystic ovarian syndrome (PCOS). We conducted a systematic review (SR) and meta-analysis of the subject before designing and implementing a randomized controlled trial (RCT). The RCT was terminated for recruitment issues. Our PCOS SR led us to develop a novel ovarian stimulation protocol for poor responders. We used the lessons learned from our failed RCT and another systematic review to design and conduct a feasibility randomized controlled trial on the use of aromatase inhibitors to improve pregnancy outcomes for in-vitro fertilization in poor responders. We successfully completed the pilot study and found a trend towards increased clinical pregnancy rates for patients who received the study versus the standard protocol. The pilot study provides recommendations for the definitive trial.