Al-Inany Hesham, Aboulghar Mohamed A, Mansour Ragaa T, Proctor Michelle
The Egyptian IVF-ET Center, Maadi, Cairo, Egypt.
Hum Reprod. 2005 Aug;20(8):2061-73. doi: 10.1093/humrep/dei035.
The objective of this systematic review was to assess the safety and efficacy of subcutaneous recombinant (r) HCG and high-dose rLH compared with intramuscular urinary (u) uHCG for inducing final oocyte maturation and triggering ovulation.
We searched the Cochrane Menstrual Disorders and Subfertility Group trials register (August 27, 2003), the Cochrane Central Register of Controlled Trials (CENTRAL on The Cochrane Library, issue 4, 2003), MEDLINE (1966 to February 2004) and EMBASE (1980 to February 2004). Searches were not limited by language. The bibliographies of included and excluded trials and abstracts of major meetings were searched for additional trials. Authors and pharmaceutical companies were contacted for missing and unpublished data. Only truly randomized controlled trials (RCTs) were included. Assessment of inclusion/exclusion, quality assessment and data extraction were performed independently by at least two reviewers.
Seven RCTs were identified, four comparing rHCG and uHCG and three comparing rhLH and uHCG. There was no statistically significant difference between rHCG and uHCG regarding the ongoing pregnancy/live birth rate [odds ratio (OR) 0.98; 95% confidence interval (CI) 0.69-1.39], clinical pregnancy rate, miscarriage rate or incidence of ovarian hyperstimulation syndrome (OHSS). There was no statistically significant difference between rhLH and uHCG regarding the ongoing pregnancy/live birth rate (OR 0.94; 95% CI 0.50-1.76), pregnancy rate, miscarriage rate or incidence of OHSS. rHCG was associated with a reduction in the incidence of local site reactions (OR 0.47; 95% CI 0.32-0.70).
According to these data, there is no evidence of a difference in clinical outcomes between urinary and recombinant gonadotrophins used for induction of final follicular maturation. Additional factors should be considered when choosing gonadotrophin type, including safety, cost and drug availability.
本系统评价的目的是评估皮下注射重组（r）人绒毛膜促性腺激素（HCG）和高剂量r促黄体生成素（rLH）与肌肉注射尿源性（u）人绒毛膜促性腺激素（uHCG）相比，在诱导最终卵母细胞成熟和触发排卵方面的安全性和有效性。
我们检索了Cochrane月经紊乱与不育症研究组试验注册库（2003年8月27日）、Cochrane对照试验中心注册库（Cochrane图书馆第4期，2003年）、医学期刊数据库（MEDLINE，1966年至2004年2月）和荷兰医学文摘数据库（EMBASE，1980年至2004年2月）。检索不受语言限制。对纳入和排除试验的参考文献以及主要会议的摘要进行检索以寻找其他试验。与作者和制药公司联系以获取缺失和未发表的数据。仅纳入真正的随机对照试验（RCT）。纳入/排除评估、质量评估和数据提取由至少两名评审员独立进行。
共识别出7项RCT，其中4项比较rHCG和uHCG，3项比较rhLH和uHCG。在持续妊娠/活产率[优势比（OR）0.98；95%置信区间（CI）0.69 - 1.39]、临床妊娠率、流产率或卵巢过度刺激综合征（OHSS）发生率方面，rHCG和uHCG之间无统计学显著差异。在持续妊娠/活产率（OR 0.94；95% CI 0.50 - 1.76）、妊娠率、流产率或OHSS发生率方面，rhLH和uHCG之间无统计学显著差异。rHCG与局部部位反应发生率降低相关（OR 0.47；95% CI 0.32 - 0.70）。
根据这些数据，没有证据表明用于诱导最终卵泡成熟的尿源性和重组促性腺激素在临床结局上存在差异。选择促性腺激素类型时应考虑其他因素，包括安全性、成本和药物可及性。
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