Li Xueying, Cao Yafang, Lin Jinli, Cai Rui, Zhang Linhao, Liu Yao
Department of Obstetrics and Gynecology, Centre for Reproductive Medicine, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.
Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China.
J Obstet Gynaecol. 2025 Dec;45(1):2444496. doi: 10.1080/01443615.2024.2444496. Epub 2024 Dec 28.
The gonadotropin-releasing hormone antagonist (GnRH-ant) protocol is associated with few oocytes retrieved, few mature oocytes and poor endometrial receptivity. Omission of GnRH-ants on trigger day seems unlikely to induce preovulation and may improve outcomes in the GnRH-ant protocol. This study aimed to systematically evaluate the effects of GnRH-ant cessation on trigger day on in vitro fertilisation outcomes following the GnRH-ant protocol.
We searched PubMed, Ovid/MEDLINE, Wanfang, VIP, CNKI and ClinicalTrials.gov databases. The last search was conducted on 10 December 2023 in English or Chinese, without time limitations on the collection of studies from the databases. The references in these articles were manually searched. Randomised controlled trials (RCTs) and cohort studies aimed at assessing the effects of GnRH-ant cessation on trigger day using the GnRH-ant protocol were included. The eligible studies included at least one of the main outcomes: number of oocytes retrieved, proportion of mature oocytes, implantation rate or clinical pregnancy rate.
Three studies with 1449 cycles were included. Cessation of GnRH-ant on trigger day improved the proportion of mature oocytes (odds ratio [OR] = 1.26, 95% confidence interval [CI] = 1.09-1.45, = 0%) but did not affect the number of oocytes retrieved (mean difference [MD] = 0.50, 95% CI = -0.07 to 1.07, = 47%), implantation rate (OR = 0.95, 95% CI = 0.69-1.30, = 0%), clinical pregnancy rate (OR = 1.06, 95% CI = 0.71-1.58, = 0%), endometrial thickness (MD = -0.09, 95% CI = -0.27 to 0.10, = 0%) or cycle cancellation rate (OR = 0.64, 95% CI = 0.15-2.74, I = 0%).
Cessation of GnRH-ant on trigger day of the GnRH-ant protocol is suggested because it could improve the proportion of mature oocytes. However, further RCTs are required.
促性腺激素释放激素拮抗剂（GnRH-ant）方案与获卵数少、成熟卵母细胞数量少及子宫内膜容受性差有关。在扳机日停用GnRH-ant似乎不太可能诱发排卵提前，且可能改善GnRH-ant方案的结局。本研究旨在系统评价在GnRH-ant方案中扳机日停用GnRH-ant对体外受精结局的影响。
我们检索了PubMed、Ovid/MEDLINE、万方、维普、中国知网和ClinicalTrials.gov数据库。最后一次检索于2023年12月10日进行，检索语言为英文或中文，对数据库中研究的收集无时间限制。对这些文章中的参考文献进行了手动检索。纳入旨在评估在GnRH-ant方案中扳机日停用GnRH-ant影响的随机对照试验（RCT）和队列研究。符合条件的研究包括以下至少一项主要结局：获卵数、成熟卵母细胞比例、种植率或临床妊娠率。
纳入了3项研究，共1449个周期。在扳机日停用GnRH-ant可提高成熟卵母细胞比例（优势比[OR]=1.26，95%置信区间[CI]=1.09-1.45，I²=0%），但不影响获卵数（平均差[MD]=0.50，95%CI=-0.07至1.07，I²=47%）、种植率（OR=0.95，95%CI=0.69-1.30，I²=0%）、临床妊娠率（OR=1.06，95%CI=0.71-1.58，I²=0%）、子宫内膜厚度（MD=-0.09，95%CI=-0.27至0.10，I²=0%）或周期取消率（OR=0.64，95%CI=0.15-2.74，I²=0%）。
建议在GnRH-ant方案的扳机日停用GnRH-ant，因为它可以提高成熟卵母细胞比例。然而，还需要进一步的随机对照试验。
