Tamoxifen versus clomiphene citrate for ovulation induction in infertile women

This systematic review aimed to compare the clinical efficacy of tamoxifen with that of clomiphene citrate (CC) in anovulatory patients. The PubMed, EMBASE, and CNKI databases were searched up to October 2016 for literature comparing tamoxifen with CC in anovulatory women. The pooled risk ratios (RR) or standardized mean differences (SMD) with 95% confidence intervals (CIs) were subjected to statistical analysis. Twelve studies involving 1302 patients with 2030 ovulation-induction cycles were summarized. There were no statistically significant differences for the ovulation and pregnancy rates in the tamoxifen comparing to the CC group in the pooled analysis. However, in the subgroup of case-control studies, tamoxifen was identified to be associated with higher ovulation (RR = 1.28, 95% CI: 1.07, 1.54, I2 = 0.0%) and pregnancy rates (RR = 1.82, 95% CI: 1.09, 3.06, I2 = 0.0%) than CC. However, no differences were detected in the subgroup of RCTs, even after sensitivity analyses. In addition, no significant differences were found in endometrial thickness and miscarriage rate. Our study showed that there might be some distinctions in the efficacy of TMX and CC for ovulation and pregnancy rates. However, the exact efficacy was needed to be confirmed further.