Liang Yufei, Zhang Qiquan, Lou Zhaoxia
Department of Gynecology and Obstetrics, Huzhou Maternity & Child Health Care Hospital, Huzhou, Zhejiang, China.
Front Endocrinol (Lausanne). 2025 Jun 5;16:1545508. doi: 10.3389/fendo.2025.1545508. eCollection 2025.
This study aims to investigate the effects of pre-treatment with Combined Oral Contraceptives (COC) on the prognosis of individuals with polycystic ovary syndrome (PCOS) who undergo assisted reproductive technology (ART).
Three databases (PubMed, Embase, and Cochrane Library) were searched from their establishment until February 23, 2024. Literature screening was performed based on predefined inclusion and exclusion criteria. Meta-analysis was executed using Stata 14.0 software, with outcomes expressed as mean differences (MD) and odds ratios (ORs), with 95% confidence intervals (CIs).
Our comprehensive analysis comprised of 11 studies, encompassing a total of 4413 patients diagnosed with PCOS. Meta-analysis results revealed that, compared to no pre-treatment, the use of COC pre-treatment did not significantly improve clinical pregnancy rates (OR: 0.96, 95% CI: 0.85 to 1.09), cumulative pregnancy rates (OR: 1.13, 95% CI: 0.92 to 1.39), or implantation rates (OR: 1.16, 95% CI: 0.99 to 1.36). However, the use of COC pre-treatment was found to be linked to a higher rate of miscarriage (OR: 1.29, 95% CI: 1.01 to 1.65). Additionally, it did not have a significant impact on the rate of live births (OR: 0.81, 95% CI: 0.68 to 0.97), cumulative live births (OR: 0.90, 95% CI: 0.78 to 1.04), or the occurrence of OHSS (OR: 0.83, 95% CI: 0.54 to 1.28). Gonadotropin dosage required for ovarian stimulation also showed no significant difference (MD: -15.32, 95% CI: -79.79 to 49.15). At the same time, we analyzed different ovulation induction regimens and found that there was no statistically significant miscarriage rate between the GnRH agonist (standard long regimen) after COC pre-treatment and the control group (OR: 1.12, 95% CI: 0.79 to 1.59), while there was no significant difference between the live birth rate with GnRH agonist (standard long regimen) after contraceptive pre-treatment and the control group (OR: 0.85, 95% CI: 0.64 to 1.14).
Administering COC pre-treatment for patients with PCOS undergoing ART does not provide substantial advantages in terms of clinical pregnancy, cumulative pregnancy, live birth rates, or the reduction of OHSS incidence. However, it is associated with an increased risk of miscarriage.
https://www.crd.york.ac.uk/prospero, identifier CRD42024528652.
本研究旨在探讨复方口服避孕药（COC）预处理对接受辅助生殖技术（ART）的多囊卵巢综合征（PCOS）患者预后的影响。
检索了三个数据库（PubMed、Embase和Cochrane图书馆），检索时间从建库至2024年2月23日。根据预先设定的纳入和排除标准进行文献筛选。使用Stata 14.0软件进行荟萃分析，结果以平均差（MD）和比值比（OR）表示，并给出95%置信区间（CI）。
我们的综合分析包括11项研究，共纳入4413例诊断为PCOS的患者。荟萃分析结果显示，与未进行预处理相比，使用COC预处理并未显著提高临床妊娠率（OR：0.96，95%CI：0.85至1.09）、累积妊娠率（OR：1.13，95%CI：0.92至1.39）或着床率（OR：1.16，95%CI：0.99至1.36）。然而，发现使用COC预处理与较高的流产率相关（OR：1.29，95%CI：1.01至1.65）。此外，它对活产率（OR：0.81，95%CI：0.68至0.97）、累积活产率（OR：0.90，95%CI：0.78至1.04）或卵巢过度刺激综合征（OHSS）的发生率（OR：0.83，95%CI：0.54至1.28）均无显著影响。卵巢刺激所需的促性腺激素剂量也无显著差异（MD：-15.32，95%CI：-79.79至49.15）。同时，我们分析了不同的促排卵方案，发现COC预处理后使用GnRH激动剂（标准长方案）与对照组之间的流产率无统计学显著差异（OR：1.12，95%CI：0.79至1.59），而避孕药预处理后使用GnRH激动剂（标准长方案）与对照组之间的活产率也无显著差异（OR：0.85，95%CI：0.64至1.14）。
对接受ART的PCOS患者进行COC预处理在临床妊娠、累积妊娠、活产率或降低OHSS发生率方面没有实质性优势。然而，它与流产风险增加相关。
