González-Comadran Mireia, Olmos Esteban Alwane, Mariño Mauricio Alexis Agüero, Vizcaíno Miguel Angel Checa
Department of Obstetrics and Gynecology, Hospital del Mar, Barcelona, Spain.
Obstetrics and Gynaecology Department, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain.
JBRA Assist Reprod. 2025 Sep 22;29(3):507-519. doi: 10.5935/1518-0557.20250012.
This systematic review and meta-analysis aimed to evaluate the benefit of GnRH agonist (GnRHa) in reproductive outcomes among women with adenomyosis undergoing IVF. The utility of GnRHa protocols for controlled ovarian stimulation (COS) and fresh embryo transfer, and the pretreatment with GnRHa before frozen-thawed embryo transfer were evaluated. The search spanned studies published in MEDLINE and Embase databases up to April 2024. Eight retrospective studies were included. The use of long GnRHa and antagonist protocol before COS exhibited significantly higher implantation rate compared to ultra-long GnRHa (OR 1.1, 95% CI 0.69-1.77 and OR 1.98, 95% CI 1.04-3.75, respectively), although no significant differences were observed in clinical and live birth rates. However, antagonist compared to long GnRHa protocol before COS improved live birth rate (OR 2.59, 95% CI 1.03-6.52). Pretreatment with GnRHa before FET among women with adenomyosis did not improve reproductive outcomes. In conclusion, there is no evidence regarding benefit of long or ultra-long GnRHa protocol before COS or before FET among women with adenomyosis undergoing IVF. In fact, the use of long GnRHa seem to worsen reproductive outcomes compared to antagonist protocols. Prospective trials are needed to assess the potential benefit of GnRHa among women with adenomyosis seeking fertility.
本系统评价和荟萃分析旨在评估促性腺激素释放激素激动剂（GnRHa）对接受体外受精（IVF）的子宫腺肌病女性生殖结局的益处。评估了GnRHa方案在控制性卵巢刺激（COS）和新鲜胚胎移植中的效用，以及在冻融胚胎移植前使用GnRHa预处理的情况。检索范围涵盖截至2024年4月发表在MEDLINE和Embase数据库中的研究。纳入了八项回顾性研究。与超长GnRHa方案相比，在COS前使用长效GnRHa和拮抗剂方案的着床率显著更高（分别为OR 1.1，95%CI 0.69 - 1.77和OR 1.98，95%CI 1.04 - 3.75），尽管在临床妊娠率和活产率方面未观察到显著差异。然而，与COS前使用长效GnRHa方案相比，拮抗剂方案提高了活产率（OR 2.59，95%CI 1.03 - 6.52）。子宫腺肌病女性在冻融胚胎移植（FET）前使用GnRHa预处理并未改善生殖结局。总之，没有证据表明在接受IVF的子宫腺肌病女性中，COS前或FET前使用长效或超长GnRHa方案有益。事实上，与拮抗剂方案相比，使用长效GnRHa似乎会使生殖结局恶化。需要进行前瞻性试验来评估GnRHa对寻求生育的子宫腺肌病女性的潜在益处。
