Kuan Kevin K W, Omoseni Sean, Tello Javier A
School of Medicine, University of St Andrews, St Andrews, UK.
Edinburgh Medical School, University of Edinburgh, Edinburgh, UK.
Ther Adv Endocrinol Metab. 2023 Jul 4;14:20420188231173325. doi: 10.1177/20420188231173325. eCollection 2023.
Endometriosis is an oestrogen-dependent disease that can cause subfertility in women who may require assisted reproductive technology (ART) to achieve their pregnancy goals.
The aim of this study was to compare ART outcomes in women with endometriosis following the long GnRH-agonist controlled ovarian stimulation (COS) protocol with those taking the GnRH-antagonist COS protocol.
MEDLINE, Embase and Web of Science were systematically searched in June 2022. Randomized controlled trials (RCTs) and observational studies comparing the long GnRH-agonist COS protocol and the GnRH-antagonist COS protocol in women with all stages/subtypes of endometriosis were included. Data were synthesized into comprehensive tables for systematic review. The Scottish Intercollegiate Guidelines Network (SIGN) checklists were used for the risk of bias assessment of non-randomized studies and randomized studies, and all the included studies were deemed to have acceptable quality.
Eight studies (one RCT and seven observational) with 2695 patients (2761 cycles) were included. Most studies generally reported non-significant differences in clinical pregnancy or live birth rates regardless of the COS protocol used. However, the GnRH-agonist protocol may yield a higher total number of oocytes retrieved, especially mature oocytes. Conversely, the GnRH-antagonist protocol required a shorter COS duration and lower gonadotrophin dose. Adverse outcomes, such as rates of cycle cancellation and miscarriage, were similar between both COS protocols.
Both the long GnRH-agonist and GnRH-antagonist COS protocols generally yield similar pregnancy outcomes. However, the long GnRH-agonist protocol may be associated with a higher cumulative pregnancy rate due to the higher number of retrieved oocytes available for cryopreservation. The underlying mechanisms of the two COS protocols on the female reproductive tract remain unclear. Clinicians should consider treatment costs, stage/subtype of endometriosis and pregnancy goals of their patients when selecting a GnRH analogue for COS. A well-powered RCT is needed to minimize the risk of bias and compare the risk for ovarian hyperstimulation syndrome.
This review was prospectively registered at PROSPERO under Registration No. CRD42022327604.
子宫内膜异位症是一种雌激素依赖性疾病，可导致女性生育力低下，这些女性可能需要辅助生殖技术（ART）来实现怀孕目标。
本研究的目的是比较接受长效促性腺激素释放激素（GnRH）激动剂控制性卵巢刺激（COS）方案的子宫内膜异位症女性与接受GnRH拮抗剂COS方案的女性的ART结局。
于2022年6月对MEDLINE、Embase和科学网进行了系统检索。纳入了比较所有分期/亚型子宫内膜异位症女性的长效GnRH激动剂COS方案和GnRH拮抗剂COS方案的随机对照试验（RCT）和观察性研究。数据被综合到综合表格中进行系统评价。苏格兰校际指南网络（SIGN）清单用于非随机研究和随机研究的偏倚风险评估，所有纳入研究均被认为质量可接受。
纳入了8项研究（1项RCT和7项观察性研究），共2695例患者（2761个周期）。大多数研究总体上报告，无论使用何种COS方案，临床妊娠率或活产率均无显著差异。然而，GnRH激动剂方案可能获得更高的获卵总数，尤其是成熟卵母细胞。相反，GnRH拮抗剂方案所需的COS持续时间更短，促性腺激素剂量更低。两种COS方案的不良结局，如周期取消率和流产率相似。
长效GnRH激动剂和GnRH拮抗剂COS方案通常产生相似的妊娠结局。然而，由于可用于冷冻保存的获卵数较多，长效GnRH激动剂方案可能与更高的累积妊娠率相关。两种COS方案对女性生殖道的潜在机制仍不清楚。临床医生在为COS选择GnRH类似物时，应考虑治疗成本、子宫内膜异位症的分期/亚型以及患者的妊娠目标。需要开展一项样本量充足的RCT，以尽量减少偏倚风险并比较卵巢过度刺激综合征的风险。
本综述已在PROSPERO上进行前瞻性注册，注册号为CRD42022327604。
