Chienvichai Pongpawan, Jansaka Natpat, Sanmee Usanee, Charoenkwan Kittipat
Chiang Mai University Department of Obstetrics and Gynecology Faculty of Medicine Chiang Mai Thailand Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
JBRA Assist Reprod. 2024 Dec 3;28(4):691-700. doi: 10.5935/1518-0557.20240054.
This systematic review and meta-analysis of randomized controlled trials aimed to evaluate the effect of a single-dose gonadotropin-releasing hormone agonist administration in the frozen-thawed embryo transfer cycle on pregnancy outcomes. A literature search was strategically conducted using PubMed, EMBASE, and the Cochrane Controlled Trials Register. The primary outcome was the clinical pregnancy rate. The secondary outcomes combined chemical pregnancy rate, implantation rate, ongoing pregnancy rate, live birth rate, miscarriage rate, and extrauterine pregnancy rate. Out of the 1594 citations that were found, only six met the criteria for being included in the meta-analysis. The clinical pregnancy rate was higher in the treatment group than in the control group (52.05% vs. 47.29%; p=0.04; RR=1.09; 95% CI=1.00-1.18). According to subgroup analysis based on the natural cycle, the clinical pregnancy rate with the agonist administration is significantly higher (43.75% vs. 27.35%; p=0.01; RR=1.6; 95% CI=1.10-2.32). However, there was no difference between the groups in terms of artificial cycles (p=0.80; 95% CI=0.96-1.20). The secondary outcomes did not show significant differences. We concluded that supplementing with a single dose of gonadotrophin-releasing hormone agonist can marginally increase the clinical pregnancy rate, particularly in the natural cycle. Other pregnancy outcomes do not improve with the treatment.
本项对随机对照试验的系统评价和荟萃分析旨在评估在冻融胚胎移植周期中单次注射促性腺激素释放激素激动剂对妊娠结局的影响。我们通过PubMed、EMBASE和Cochrane对照试验注册库进行了策略性文献检索。主要结局指标为临床妊娠率。次要结局指标包括化学妊娠率、着床率、持续妊娠率、活产率、流产率和宫外孕率。在检索到的1594篇文献中，仅有6篇符合纳入荟萃分析的标准。治疗组的临床妊娠率高于对照组（52.05% 对47.29%；p = 0.04；RR = 1.09；95% CI = 1.00 - 1.18）。根据基于自然周期的亚组分析，使用激动剂后的临床妊娠率显著更高（43.75% 对27.35%；p = 0.01；RR = 1.6；95% CI = 1.10 - 2.32）。然而，在人工周期方面两组之间没有差异（p = 0.80；95% CI = 0.96 - 1.20）。次要结局指标未显示出显著差异。我们得出结论，补充单次剂量的促性腺激素释放激素激动剂可略微提高临床妊娠率，尤其是在自然周期中。该治疗方法并未改善其他妊娠结局。
