Gaps in the evidence for fertility treatment-an analysis of the Cochrane Menstrual Disorders and Subfertility Group database.
BACKGROUND
The randomized controlled trial is considered the best approach to assess the effectiveness of treatments. The aim was to summarize the available evidence and determine gaps in the evidence for clinical decision making in subfertility.


METHODS
A search of the Cochrane Library for Menstrual Disorders and Subfertility Group reviews was undertaken and, where the reviews were related to subfertility, the authors' conclusions were appraised and correlated with the results and meta-analysis sections of the reviews. Each review was then categorized as to what extent it had answered the clinical question posed by the reviewers.


RESULTS
Of 38 subfertility reviews currently or previously published on the Cochrane Library from the Menstrual Disorders and Subfertility Group, 12 reviews concluded that there was evidence of effectiveness of the interventions studied. There was insufficient evidence of effectiveness in 26 reviews, from which the authors of 23 reviews called for further research. A tabulated summary of the review conclusions is presented.


CONCLUSIONS
Cochrane subfertility reviews have eliminated some gaps in the evidence and highlighted others. Future clinical trial design should focus on adequate power and reporting the major outcome of live-births per couple as well as adverse events.
Johnson
N P
NP
Cochrane Menstrual Disorders & Subfertility Group Editorial Base, University of Auckland, and Fertility Plus, Obstetrics & Gynaecology Department, National Women's Hospital, Auckland, New Zealand. n.johnson@auckland.ac.nz
Proctor
M
M
Farquhar
C M
CM
D016208:Databases, Factual; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D007246:Infertility / Q000209:etiology / Q000628:therapy*; D008297:Male; D027724:Reproductive Techniques, Assisted; D016896:Treatment Outcome