State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, 400016, China.
The Reproductive Hospital of Guangxi Zhuang Autonomous Region, Nanning, China.
J Ovarian Res. 2024 Jun 21;17(1):130. doi: 10.1186/s13048-024-01410-7.
This study was aimed to systematically evaluate the efficacy of artificial cycle-prepared frozen-thawed embryo transfer (FET) with or without gonadotrophin-releasing hormone agonist (GnRH-a) pretreatment for women with polycystic ovary syndrome (PCOS).
The analysis was carried out by searching the PubMed, EMBASE, and CNKI databases with a combination of keywords before October 2021. The available studies of the effects of GnRH-a pretreatment or no pretreatment on FET in PCOS patients were considered. The risk ratios (RRs) or standardized mean differences (SMD) with 95% confidence intervals (CIs) were calculated with using subgroups and sensitivity analysis. The quality evaluation for this analysis was followed.
Seventeen studies including 3646 women were analyzed. GnRH-a pretreatment was significantly associated with a higher implantation rate (RR = 1.12, 95%CI: 1.00-1.24) and clinical pregnancy rate (RR = 1.19, 95%CI: 1.08-1.32) than the placebo. Moreover, in the GnRH-a pretreatment group, significant differences were detected for increasing the endometrium thickness among PCOS patients (SMD = 0.56, 95%CI: 0.20-0.92). However, for RCTs subgroup, no differences were observed, even after sensitivity analyses. In addition, the miscarriage rates, ectopic pregnancy rates, multiple pregnancy rates, and live birth rates were similar in both two groups.
Endometrial preparation using GnRH agonist pretreatment prior to FET seems to be the better choice for PCOS patients. However, well-designed RCTs are required for confirmation.
本研究旨在系统评价在接受冻融胚胎移植（FET）时是否应用促性腺激素释放激素激动剂（GnRH-a）预处理对多囊卵巢综合征（PCOS）患者的疗效。
检索 PubMed、EMBASE 和中国知网（CNKI）数据库，组合关键词进行分析，检索时间截至 2021 年 10 月。纳入 GnRH-a 预处理或不预处理对 PCOS 患者 FET 影响的研究。采用亚组分析和敏感性分析计算风险比（RR）或标准化均数差（SMD）及其 95%置信区间（CI）。本分析遵循质量评价。
共纳入 17 项研究，包括 3646 名女性。与安慰剂相比，GnRH-a 预处理可显著提高胚胎着床率（RR=1.12，95%CI：1.00-1.24）和临床妊娠率（RR=1.19，95%CI：1.08-1.32）。此外，在 GnRH-a 预处理组中，PCOS 患者的子宫内膜厚度显著增加（SMD=0.56，95%CI：0.20-0.92）。然而，在随机对照试验（RCT）亚组中，即使经过敏感性分析，也未观察到差异。此外，两组患者的流产率、异位妊娠率、多胎妊娠率和活产率相似。
在 FET 前应用 GnRH 激动剂预处理子宫内膜似乎是 PCOS 患者的更好选择。然而，需要进行设计良好的 RCT 来进一步证实。
