Mao Routong, Hou Xiaohong, Feng Xiao, Wang Ruina, Fei Xiaofan, Zhao Junzhao, Chen Hui, Cheng Jing
Reproductive Center, Department of Obstetrics and Gynecology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China.
School of Life Sciences, Faculty of Science, University of Technology Sydney, Sydney, NSW, Australia.
Front Pharmacol. 2024 Jul 29;15:1434625. doi: 10.3389/fphar.2024.1434625. eCollection 2024.
The optimal dosage of recombinant human luteinizing hormone (r-hLH) and its impact on endometrial thickness (EMT) when administered alongside recombinant human follicle-stimulating hormone (r-hFSH) during controlled ovarian stimulation (COS) for fertilization/intracytoplasmic sperm injection and embryo transfer are uncertain, which formed the aims of this systematic review and meta-analysis.
A search was performed in PubMed, Cochrane Library, Web of Science, EMBASE, CNKI, and Wanfang from its inception to 10 July 2023. Twenty-seven Randomized controlled trials comparing r-hFSH/r-hLH co-treatment with r-hFSH alone during fertilization/intracytoplasmic sperm injection and embryo transfer (IVF/ICSI-ET) were included. Pooled odds ratios (OR) for dichotomous data and mean differences (MD) for continuous data, with their respective 95% confidence intervals (CI), were generated. Meta-analysis employed fixed-effect or random-effect models based on heterogeneity, using Q-test and I2-index calculations. The main outcomes included EMT on trigger day, clinical pregnancy rate (CPR) and live birth rate (LBR).
r-hFSH/r-hLH significantly increased EMT on trigger day (MD = 0.27; 95% CI, 0.11-0.42; I = 13%), but reduced oocyte number (MD = -0.60; 95% CI, -1.07 to -0.14; I = 72%) and high-quality embryos (MD = -0.76; 95% CI, -1.41 to -0.10; I = 94%) than r-hFSH alone, more pronounced with the gonadotrophin-releasing hormone agonist long protocol. A subgroup analysis showed r-hLH at 75 IU/day increased CPR (OR = 1.23; 95% CI, 1.02-1.49; I = 16%) and EMT on trigger day (MD = 0.40; 95% CI, 0.19-0.61; I = 0%). Participants ≥35 years of age exhibited decreased retrieved oocytes (MD = -1.26; 95% CI, -1.78 to -0.74; I = 29%), but an increase in EMT on trigger day (MD = 0.26; 95% CI, 0.11-0.42; I = 29%).
r-hFSH/r-hLH during COS significantly improved EMT compared to r-hFSH alone. An r-hLH dose of 75 IU/day may be considered for optimal pregnancy outcomes, which still require further clinical studies to support this dosing regime.
[www.crd.york.ac.uk/PROSPERO], identifier [CRD42023454584].
在控制性卵巢刺激（COS）期间，当重组人促黄体生成素（r-hLH）与重组人促卵泡生成素（r-hFSH）联合用于受精/卵胞浆内单精子注射和胚胎移植时，其最佳剂量及其对子宫内膜厚度（EMT）的影响尚不确定，这构成了本系统评价和荟萃分析的目的。
从创刊至2023年7月10日，在PubMed、Cochrane图书馆、Web of Science、EMBASE、中国知网和万方数据库进行检索。纳入了27项随机对照试验，这些试验比较了在受精/卵胞浆内单精子注射和胚胎移植（IVF/ICSI-ET）期间r-hFSH/r-hLH联合治疗与单独使用r-hFSH的效果。生成了二分数据的合并比值比（OR）和连续数据的平均差（MD）及其各自的95%置信区间（CI）。荟萃分析根据异质性采用固定效应或随机效应模型，使用Q检验和I²指数计算。主要结局包括扳机日的EMT、临床妊娠率（CPR）和活产率（LBR）。
与单独使用r-hFSH相比，r-hFSH/r-hLH显著增加了扳机日的EMT（MD = 0.27；95%CI，0.11 - 0.42；I² = 13%），但卵母细胞数量减少（MD = -0.60；95%CI，-1.07至-0.14；I² = 72%），优质胚胎数量减少（MD = -0.76；95%CI，-1.41至-0.10；I² = 94%），在促性腺激素释放激素激动剂长方案中更为明显。亚组分析显示，每天75 IU的r-hLH可提高CPR（OR = 1.23；95%CI，1.02 - 1.49；I² = 16%）和扳机日的EMT（MD = 0.40；95%CI，0.19 - 0.61；I² = 0%）。年龄≥35岁的参与者回收的卵母细胞减少（MD = -1.26；95%CI，-1.78至-0.74；I² = 29%），但扳机日的EMT增加（MD = 0.26；95%CI，0.11 - 0.42；I² = 29%）。
与单独使用r-hFSH相比
