孕激素预处理卵巢刺激方案对卵巢储备功能下降患者行 IVF/ICSI 的临床价值：系统评价和荟萃分析。
The clinical value of progestin-primed ovarian stimulation protocol for women with diminished ovarian reserve undergoing IVF/ICSI: a systematic review and meta-analysis.
机构信息
Department of Gynecology, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
Department of Reproductive Center, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China.
出版信息
Front Endocrinol (Lausanne). 2023 Aug 21;14:1232935. doi: 10.3389/fendo.2023.1232935. eCollection 2023.
BACKGROUND
To determine whether progestin-primed ovarian stimulation (PPOS) is more effective for women with diminished ovarian reserve (DOR) than clomiphene citrate (CC)/letrozole (LE) plus gonadotropin in IVF or ICSI treatment.
METHODS
Nine databases were searched until May 24, 2023, to identify relevant studies. Forest plots were used to present the results of this meta-analysis. Begg's and Egger's tests were applied to estimate publication bias. Subgroup and sensitivity analysis were performed to check the potential sources of heterogeneity and verify the robustness of the pooled results, respectively.
RESULTS
A total of 14 studies with 4182 participants were included for meta-analysis. There was evidence of a statistically notable increase in clinical pregnancy rate (OR = 1.39, 95%CI [1.01, 1.91], = 0.05), optimal embryos rate (OR = 1.50, 95%CI [1.20, 1.88], = 0.0004), and cumulative pregnancy rate (OR = 1.73, 95%CI [1.14, 2.60], = 0.009), the duration and the amount of gonadotropin required (MD = 1.56, 95%CI [0.47, 2.66], = 0.005; SMD = 1.51, 95%CI [0.90, 2.12], < 0.00001), along with decrease cycle cancellation rate (OR = 0.78, 95%CI [0.64, 0.95], = 0.02), luteinizing hormone (LH) level on the day of hCG (SMD = -0.81, 95%CI [-1.10, -0.53], < 0.00001), and premature LH surge rate (OR = 0.10, 95%CI [0.07, 0.15], < 0.00001) when PPOS was used. No evidence for publication bias within results was revealed.
CONCLUSIONS
Based on evidence-based results, PPOS protocol seems to improve IVF/ICSI outcomes for women with DOR. More research with larger sample sizes and rigorous designs are required to further explore the value of PPOS among women diagnosed with DOR.
SYSTEMATIC REVIEW REGISTRATION
www.crd.york.ac.uk, identifier CRD42023430202.
背景
为了确定孕激素预处理的卵巢刺激（PPOS）是否比枸橼酸氯米芬（CC）/来曲唑（LE）联合促性腺激素在体外受精或卵胞浆内单精子注射（ICSI）治疗中对卵巢储备功能降低（DOR）的女性更有效。
方法
检索了 9 个数据库，截至 2023 年 5 月 24 日，以确定相关研究。使用森林图展示荟萃分析的结果。贝叶斯（Begg）和埃格（Egger）检验用于估计发表偏倚。进行亚组和敏感性分析，以分别检查异质性的潜在来源和验证汇总结果的稳健性。
结果
共有 14 项研究，涉及 4182 名参与者，进行了荟萃分析。有证据表明，临床妊娠率（OR = 1.39，95%CI [1.01，1.91]， = 0.05）、优质胚胎率（OR = 1.50，95%CI [1.20，1.88]， = 0.0004）和累积妊娠率（OR = 1.73，95%CI [1.14，2.60]， = 0.009）、促性腺激素的使用时间和用量（MD = 1.56，95%CI [0.47，2.66]， = 0.005；SMD = 1.51，95%CI [0.90，2.12]， ＜0.00001）、周期取消率（OR = 0.78，95%CI [0.64，0.95]， = 0.02）、人绒毛膜促性腺激素（hCG）日 LH 水平（SMD = -0.81，95%CI [-1.10，-0.53]， ＜0.00001）和黄体生成素（LH）过早激增率（OR = 0.10，95%CI [0.07，0.15]， ＜0.00001）降低，当使用 PPOS 时。结果未显示存在发表偏倚的证据。
结论
基于循证结果，PPOS 方案似乎可以改善 DOR 女性的体外受精/卵胞浆内单精子注射（IVF/ICSI）结局。需要更多具有更大样本量和严格设计的研究来进一步探讨 PPOS 在诊断为 DOR 的女性中的价值。
系统评价注册
www.crd.york.ac.uk，标识符 CRD42023430202。
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