Centre for Reproductive Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands; Department of Obstetrics & Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt.
Centre for Reproductive Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands.
Fertil Steril. 2018 Feb;109(2):289-301. doi: 10.1016/j.fertnstert.2017.10.033. Epub 2018 Jan 6.
To evaluate the effectiveness of low doses of gonadotropins and gonadotropins combined with oral compounds compared with high doses of gonadotropins in ovarian stimulation regimens in terms of ongoing pregnancy per fresh IVF attempt in women with poor ovarian reserve undergoing IVF/intracytoplasmic sperm injection (ICSI) treatment.
A systematic review and meta-analysis of randomized controlled studies that evaluate the effectiveness of low dosing of gonadotropins alone or combined with oral compounds compared with high doses of gonadotropins in women with poor ovarian reserve undergoing IVF/ICSI treatment.
Not applicable.
PATIENT(S): Subfertile women with poor ovarian reserve undergoing IVF/ICSI treatment.
INTERVENTION(S): We searched the PubMed, EMBASE, Web of Science, the Cochrane Library, and the Clinical Trials Registry using medical subject headings and free text terms up to June 2016, without language or year restrictions. We included randomized controlled studies (RCTs) enrolling subfertile women with poor ovarian reserve undergoing IVF/ICSI treatment and comparing low doses of gonadotropins and gonadotropins combined with oral compounds versus high doses of gonadotropins. We assessed the risk of bias using the criteria recommended by the Cochrane Collaboration. We pooled the results by meta-analysis using the fixed and random effects model.
MAIN OUTCOMES MEASURE(S): The primary outcome was ongoing pregnancy rate (PR) per woman randomized.
RESULT(S): We retrieved 787 records. Fourteen RCTs (N = 2,104 women) were included in the analysis. Five studies (N = 717 women) compared low doses of gonadotropins versus high doses of gonadotropins. There was no evidence of a difference in ongoing PR (2 RCTs: risk rate 0.98, 95% confidence interval 0.62-1.57, I = 0). Nine studies (N = 1,387 women) compared ovarian stimulation using gonadotropins combined with the oral compounds letrozole (n = 6) or clomiphene citrate (CC) (n = 3) versus high doses of gonadotropins. There was no evidence of a difference in ongoing PR (3 RCTs: risk rate 0.90, 95% confidence interval 0.63-1.27, I = 0).
CONCLUSION(S): We found no evidence of a difference in pregnancy outcomes between low doses of gonadotropins and gonadotropins combined with oral compounds compared with high doses of gonadotropins in ovarian stimulation regimens. Whether low doses of gonadotropins or gonadotropins combined with oral compounds is to be preferred is unknown, as they have never been compared head to head. A health economic analysis to test the hypothesis that an ovarian stimulation with low dosing is more cost-effective than high doses of gonadotropins is needed.
CRD42016041301.
评估在接受体外受精/胞浆内单精子注射（IVF/ICSI）治疗的卵巢储备功能不良的妇女中，与高剂量促性腺激素相比，低剂量促性腺激素和促性腺激素联合口服化合物在卵巢刺激方案中对每个新鲜 IVF 尝试的持续妊娠率的有效性。
对评估低剂量促性腺激素单独或与口服化合物联合与高剂量促性腺激素在卵巢储备功能不良的接受 IVF/ICSI 治疗的妇女中的有效性的随机对照研究进行系统评价和荟萃分析。
不适用。
接受 IVF/ICSI 治疗的卵巢储备功能不良的不孕妇女。
我们使用医学主题词和自由文本术语，在 PubMed、EMBASE、Web of Science、Cochrane 图书馆和临床试验注册处进行了搜索，截至 2016 年 6 月，没有语言或年份限制。我们纳入了随机对照研究（RCT），纳入了接受 IVF/ICSI 治疗且卵巢储备功能不良的不孕妇女，并比较了低剂量促性腺激素和促性腺激素联合口服化合物与高剂量促性腺激素。我们使用 Cochrane 协作组推荐的标准评估偏倚风险。我们使用固定和随机效应模型通过荟萃分析合并结果。
主要结局为每个随机分组妇女的持续妊娠率。
我们检索到 787 条记录。纳入了 14 项 RCT（N = 2104 名妇女）进行分析。5 项研究（N = 717 名妇女）比较了低剂量促性腺激素与高剂量促性腺激素。持续妊娠率无差异（2 项 RCT：风险比 0.98，95%置信区间 0.62-1.57，I² = 0）。9 项研究（N = 1387 名妇女）比较了促性腺激素联合口服化合物来曲唑（n = 6）或枸橼酸氯米酚（CC）（n = 3）与高剂量促性腺激素的卵巢刺激。持续妊娠率无差异（3 项 RCT：风险比 0.90，95%置信区间 0.63-1.27，I² = 0）。
我们发现，在卵巢刺激方案中，与高剂量促性腺激素相比，低剂量促性腺激素和促性腺激素联合口服化合物与妊娠结局无差异。由于它们从未进行过头对头比较，因此尚不清楚低剂量促性腺激素或促性腺激素联合口服化合物是否更优。需要进行健康经济学分析来检验假设，即低剂量卵巢刺激比高剂量促性腺激素更具成本效益。
CRD42016041301。
