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 Table of Contents  
Year : 2018  |  Volume : 2  |  Issue : 2  |  Page : 35-36

Infertility in the middle east and North Africa Region: Does meta-analysis and systematic review of the published reports answer the undetermined questions?

Department of Medicine, Hamad General Hospital, HMC, Weill Cornell Medical College and College of Medicine, Qatar University, Doha, Qatar

Date of Web Publication29-Jun-2018

Correspondence Address:
Prof. Abdel-Naser Elzouki
Department of Medicine, Hamad General Hospital, HMC, P. O. Box: 3050, Doha
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2588-9044.235699

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How to cite this article:
Elzouki AN. Infertility in the middle east and North Africa Region: Does meta-analysis and systematic review of the published reports answer the undetermined questions?. Libyan J Med Sci 2018;2:35-6

How to cite this URL:
Elzouki AN. Infertility in the middle east and North Africa Region: Does meta-analysis and systematic review of the published reports answer the undetermined questions?. Libyan J Med Sci [serial online] 2018 [cited 2023 Feb 7];2:35-6. Available from: https://www.ljmsonline.com/text.asp?2018/2/2/35/235699

Meta-analysis is a set of techniques used to combine the results of a number of different studies into one report to create a single, more precise estimate of an effect.[1] The objectives of meta-analysis are to increase statistical power, to deal with controversy when individual studies disagree, to improve estimates of size of effect, and to answer new questions not previously posed in component studies.[2] There are several advantages to meta-analysis. It allows investigators to pool data from many trials that are too small by themselves to allow for secure conclusions. Although ideally any clinical study should plan an adequate sample size, historically many studies have been underpowered.[3] Normally, but not inevitably, the meta-analysis is based on randomized, controlled clinical studies. Outcomes from a meta-analysis may include a more precise estimate of the effect of treatment or risk factor for disease, or other outcomes, than any individual study contributing to the pooled analysis. Identifying sources of variation in responses, that is, examining heterogeneity of a group of studies and generalizability of responses can lead to more effective treatments or modifications of management. Examination of heterogeneity is perhaps the most important task in meta-analysis.[3]

The Cochrane Collaboration has been a long-standing, rigorous, and innovative leader in developing methods in the field.[4] Major contributions include the development of protocols that provide structure for literature search methods and new and extended analytic and diagnostic methods for evaluating the output of meta-analyses. Use of the methods outlined in the handbook should provide a consistent approach to the conduct of meta-analysis. Moreover, a useful guide to improve reporting of systematic reviews and meta-analyses is the Preferred Reporting Items for Systematic reviews and Meta-Analyses statement, a helpful resource to improve reporting of systematic reviews and meta-analyses, which replaced the Quality Of Reporting of Meta-analyses statement.[5] Moreover, standards by which to conduct and report meta-analyses of observational studies have been published to improve the quality of reporting.[6]

The traditional basis of medical practice has been changed by the use of randomized, blinded, clinical trials, and meta-analysis, leading to the widely used term "evidence-based medicine." The later may be defined as the systematic, quantitative, preferentially experimental approach to obtaining and using medical information.[7] Therefore, meta-analysis, a statistical procedure that integrates the results of several independent studies, plays a central role in evidence-based medicine. In fact, in the hierarchy of evidence-based medicine, where clinical evidence is ranked according to the strength of the freedom from various biases that beset medical research, meta-analyses are in the top.[8]

In the present issue of Libyan Journal of Medical Sciences, Eldib and Tashani reported a meta-analysis and systematic review to estimate the prevalence of primary and secondary infertility in Middle East and North Africa (MENA) region and produce the overall estimate of the different indicators of infertility in MENA region.[9] The prevalence of clinical primary infertility and demographic infertility found to be low at 3.8% and high at 22.6% in this region of the world, respectively. This systematic review and meta-analysis is the first review of infertility in the MENA region and provides point prevalence of infertility according to different definitions. However, results are limited by the lack of studies and surveys in most countries of the region and the lack of robust methodology in some of the surveys reported. The meta-analysis was conducted according to a random effect model, yet the high heterogeneity and publication bias among the studies and surveys is a matter of concern. Furthermore, the result is possibly limited with the inclusion of many unmarried or cohabitated women, especially in studies reported from some countries such as Morocco.

  References Top

Ferrer RL. Graphical methods for detecting bias in meta-analysis. Fam Med 1998;30:579-83.  Back to cited text no. 1
Bailar JC 3rd. The promise and problems of meta-analysis. N Engl J Med 1997;337:559-61.  Back to cited text no. 2
Cheung MW, Vijayakumar R. A guide to conducting a meta-analysis. Neuropsychol Rev 2016;26:121-8.  Back to cited text no. 3
Higgins JP, Green S, editors. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0. The Cochrane Collaboration; 2011. Available from: http://www.cochrane-handbook.org. [Last accessed on 2018 Jun 04].  Back to cited text no. 4
Moher D, Liberati A, Tetzlaff J, Altman DG; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. J Clin Epidemiol 2009;62:1006-12.  Back to cited text no. 5
Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, et al. Meta-analysis of observational studies in epidemiology: A proposal for reporting. Meta-analysis of observational studies in epidemiology (MOOSE) Group. JAMA 2000;283:2008-12.  Back to cited text no. 6
Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Richardson WS. Evidence based medicine: What it is and what it isn't. BMJ 1996;312:71-2.  Back to cited text no. 7
Haidich AB. Meta-analysis in medical research. Hippokratia 2010;14:29-37.  Back to cited text no. 8
Eldib A, Tashani OA. Infertility in the Middle East and North Africa region: A systematic review with meta-analysis of prevalence surveys. Libyan J Med Sci 2018;2:35-42.  Back to cited text no. 9


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