长效 GnRH 激动剂卵泡方案与 GnRH 拮抗剂方案在体外受精妇女中的比较：系统评价和荟萃分析。
Comparison of the Long-Acting GnRH Agonist Follicular Protocol with the GnRH Antagonist Protocol in Women Undergoing In Vitro Fertilization: A Systematic Review and Meta-analysis.
机构信息
Department of Obstetrics and Gynecology, Center for Reproductive Medicine, Peking University Third Hospital, Beijing, China.
Center for Reproductive Medicine, The Third Affiliated Hospital of Zhengzhou University, Henan Maternal and Children Health Hospital, Zhengzhou, Henan, China.
出版信息
Adv Ther. 2021 May;38(5):2027-2037. doi: 10.1007/s12325-020-01612-7. Epub 2021 Mar 2.
INTRODUCTION
To evaluate the effectiveness and safety of long-acting GnRH agonist follicular and GnRH antagonist protocols among women undergoing in vitro fertilization (IVF) using data published in both English-language and Chinese studies.
METHODS
We systematically searched the PubMed, Embase, Cochrane, CNKI, and Wanfang databases up to March 2019 for studies comparing long-acting GnRH agonist follicular and GnRH antagonist protocols in women undergoing IVF. The primary outcome was live birth rate; secondary outcomes were clinical pregnancy rate and implantation rate; safety outcomes were ovarian hyperstimulation syndrome (OHSS) and miscarriage rate in fresh cycle. Statistical analysis was done using R software. The study protocol was registered with PROSPERO (CRD42019139396).
RESULTS
In 11 studies that met the inclusion criteria, 1994 women belonged to the long-acting GnRH agonist follicular protocol group and 1678 to the GnRH antagonist protocol group. Live birth rate (relative risk (RR) 1.61; 95% confidence interval (CI) 1.27, 2.05; P < 0.001), clinical pregnancy rate (RR 1.44; 95% CI 1.32, 1.58; P < 0.001), and implantation rate (RR 1.58; 95% CI 1.44, 1.73; P = 0.001) were higher in the long-acting GnRH agonist follicular protocol compared with the antagonist protocol group. There was no difference in miscarriage rate (RR 0.98; 95% CI 0.58, 1.64; P = 0.98) between the long-acting GnRH agonist follicular and antagonist protocols. However, OHSS rate (RR 1.63; 95% CI 1.15, 2.32; P = 0.0058) was lower in the GnRH antagonist protocol compared to the long-acting GnRH agonist protocol group.
CONCLUSION
The long-acting GnRH agonist follicular protocol was beneficial in improving live birth rate, clinical pregnancy rate, and implantation rate whereas the incidence of OHSS was significantly lower in women undergoing the GnRH antagonist protocol.
介绍
使用发表于英文和中文文献中的数据，评估长效 GnRH 激动剂卵泡期和 GnRH 拮抗剂方案在接受体外受精（IVF）的女性中的有效性和安全性。
方法
我们系统地检索了 PubMed、Embase、Cochrane、CNKI 和万方数据库，以获取截至 2019 年 3 月比较长效 GnRH 激动剂卵泡期和 GnRH 拮抗剂方案在接受 IVF 的女性中的研究。主要结局为活产率；次要结局为临床妊娠率和着床率；安全性结局为新鲜周期中的卵巢过度刺激综合征（OHSS）和流产率。使用 R 软件进行统计分析。该研究方案已在 PROSPERO（CRD42019139396）注册。
结果
在符合纳入标准的 11 项研究中，1994 名女性归入长效 GnRH 激动剂卵泡期方案组，1678 名归入 GnRH 拮抗剂方案组。活产率（相对风险（RR）1.61；95%置信区间（CI）1.27，2.05；P<0.001）、临床妊娠率（RR 1.44；95%CI 1.32，1.58；P<0.001）和着床率（RR 1.58；95%CI 1.44，1.73；P=0.001）在长效 GnRH 激动剂卵泡期方案组中高于 GnRH 拮抗剂方案组。两组流产率（RR 0.98；95%CI 0.58，1.64；P=0.98）无差异。然而，与长效 GnRH 激动剂方案组相比， GnRH 拮抗剂方案组的 OHSS 发生率（RR 1.63；95%CI 1.15，2.32；P=0.0058）较低。
结论
长效 GnRH 激动剂卵泡期方案有利于提高活产率、临床妊娠率和着床率，而 GnRH 拮抗剂方案组的 OHSS 发生率显著降低。
Zotero 插件