孕激素预处理卵巢刺激在辅助生殖技术中的有效性：系统评价和荟萃分析。

Effectiveness of progesterone-primed ovarian stimulation in assisted reproductive technology: a systematic review and meta-analysis.

机构信息

Department of Reproduction and Infertility, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, China.

School of Biomedical Science, University of Queensland, St Lucia, Brisbane, QLD, Australia.

出版信息

Arch Gynecol Obstet. 2021 Mar;303(3):615-630. doi: 10.1007/s00404-020-05939-y. Epub 2021 Jan 12.

PURPOSE

Progestin-primed ovarian stimulation (PPOS) is a new ovarian stimulation protocol that has been used over the last decade to enhance reproductive function. The purpose of this study is to evaluate whether PPOS is as effective as conventional protocols (without GnRHa downregulation).

METHOD

Search terms included "medroxyprogesterone", "dydrogesterone", "progestin-primed ovarian stimulation", "PPOS", "oocyte retrieval", "in vitro fertilization", "IVF", "ICSI", "ART", and "reproductive". The selection criteria were nonrandomized studies and randomized controlled studies. For data collection and analysis, the Review Manager software, Newcastle-Ottowa Quality Assessment Scale and GRADE approach were used.

RESULTS

The clinical pregnancy rates were not significantly different in either RCTs or NRCTs [RR 0.96, 95% CI (0.69-1.33), I = 71%, P = 0.81]; [RR 0.99, 95% CI (0.83-1.17), I = 38%, P = 0.88]. The live birth rates of RCTs and NRCTs did not differ [RCT: RR 1.08, 95% CI (0.74, 1.57), I = 66%, P = 0.69; NRCT: OR 1.03 95% CI 0.84-1.26), I = 50%, P = 0.79]. The PPOS protocol had a lower rate of OHSS [RR 0.52, 95% CI (0.36-0.75), I = 0%, P = 0.0006]. The secondary results showed that compared to the control protocol, the endometrium was thicker [95% CI (0.00-0.78), I = 0%, P = 0.05], the number of obtained embryos was higher [95% CI (0.04-0.65), I = 17%, P = 0.03] and more hMG was needed [in NRCT: 95% CI (307.44, 572.73), I = 0%, P < 0.00001] with the PPOS protocol.

CONCLUSION

The PPOS protocol produces more obtained embryos and a thicker endometrium than the control protocol, with a lower rate of OHSS and an equal live birth rate. The PPOS protocol could be a safe option as a personalized protocol for infertile patients.

TRIAL REGISTRATION

Registration at PROSPERO: CRD42020176577.

目的

孕激素预处理的卵巢刺激（PPOS）是一种新的卵巢刺激方案，在过去十年中被用于增强生殖功能。本研究旨在评估 PPOS 是否与传统方案（无 GnRHa 下调）一样有效。

方法

搜索词包括“medroxyprogesterone”、“dydrogesterone”、“progestin-primed ovarian stimulation”、“PPOS”、“卵母细胞采集”、“体外受精”、“IVF”、“ICSI”、“ART”和“生殖”。选择标准是非随机研究和随机对照研究。为了进行数据收集和分析，使用了 Review Manager 软件、纽卡斯尔-渥太华质量评估量表和 GRADE 方法。

结果

RCT 和 NRCT 中的临床妊娠率均无显著差异[RR 0.96，95% CI（0.69-1.33），I = 71%，P = 0.81]；[RR 0.99，95% CI（0.83-1.17），I = 38%，P = 0.88]。RCT 和 NRCT 的活产率无差异[RCT：RR 1.08，95% CI（0.74,1.57），I = 66%，P = 0.69；NRCT：OR 1.03，95% CI 0.84-1.26），I = 50%，P = 0.79]。PPOS 方案的 OHSS 发生率较低[RR 0.52，95% CI（0.36-0.75），I = 0%，P = 0.0006]。次要结果显示，与对照组相比，PPOS 方案的子宫内膜较厚[95% CI（0.00-0.78），I = 0%，P = 0.05]，获得的胚胎数量较多[95% CI（0.04-0.65），I = 17%，P = 0.03]，需要更多的 hMG[在 NRCT 中：95% CI（307.44,572.73），I = 0%，P < 0.00001]。