Wang Min, Zheng Lianwen, Ma Shuai, Xu Ying, Zhang Jingshun, Fu Lulu
Reproductive Medical Center, Department of Obstetrics and Gynecology, The Second Hospital of Jilin University, Changchun, China.
J Assist Reprod Genet. 2025 Aug 7. doi: 10.1007/s10815-025-03612-4.
We aimed to compare the effects of the progestin-primed ovarian stimulation (PPOS) protocol and gonadotropin-releasing hormone antagonist (GnRH-A) protocol in women with different ovarian reserves who underwent assisted reproductive technology (ART).
We searched published studies in the Cochrane Library, Web of Science, Embase, PubMed, CNKI, and CBM databases. Patients in the experimental group underwent the PPOS protocol, and those in the control group underwent the GnRH-A protocol. Randomised controlled trials (RCTs) and non-randomised controlled trials (N-RCTs) of PPOS and GnRH-A protocols were collected. We searched the literature published until November 1, 2024. A subgroup analysis was performed for patients with different ovarian reserves.
This study included 36 studies. The primary outcome showed that the live birth rate was similar between the PPOS and GnRH-A groups. In the high ovarian response (HOR) patients, the incidence of ovarian hyperstimulation syndrome (OHSS) was significantly lower in the PPOS protocol group than in the GnRH-A group [OR = 0.24, 95% confidence interval (CI) = 0.12-0.48, p < 0.0001]. In the secondary outcomes, the endometrial thickness in the PPOS protocol group decreased compared with the GnRH-A group (mean difference (MD) = - 1.13, 95% CI = - 1.76 to - 0.51, p = 0.0004). In the HOR subgroup, gonadotropin (Gn) dose (MD = 222.88, 95% CI = 59.30-386.46, p = 0.008) and duration (MD = 0.70, 95% CI = 0.48-0.92, p < 0.00001) were increased in the PPOS protocol group compared with the GnRH-A protocol group. In the normal ovarian response (NOR) subgroup, the number of viable embryos in the PPOS protocol group was greater than that in the GnRH-A group (MD = 2.00, 95% CI = 0.10-3.90, p = 0.04).
The PPOS protocol had similar clinical effects to the GnRH-A protocol. In HOR patients, the Gn duration and dose in the PPOS protocol group increased, whereas OHSS incidence was reduced. Meanwhile, in NOR patients, the number of viable embryos in the PPOS protocol group increased. The PPOS protocol can be widely promoted in clinical practice when patients do not choose to proceed with fresh embryo transfer due to their own circumstances.
我们旨在比较孕激素预处理卵巢刺激（PPOS）方案和促性腺激素释放激素拮抗剂（GnRH-A）方案对接受辅助生殖技术（ART）的不同卵巢储备女性的影响。
我们检索了Cochrane图书馆、Web of Science、Embase、PubMed、中国知网（CNKI）和中国生物医学文献数据库（CBM）中的已发表研究。实验组患者采用PPOS方案，对照组患者采用GnRH-A方案。收集PPOS和GnRH-A方案的随机对照试验（RCT）和非随机对照试验（N-RCT）。我们检索了截至2024年11月1日发表的文献。对不同卵巢储备的患者进行亚组分析。
本研究纳入36项研究。主要结局显示，PPOS组和GnRH-A组的活产率相似。在高卵巢反应（HOR）患者中，PPOS方案组的卵巢过度刺激综合征（OHSS）发生率显著低于GnRH-A组[比值比（OR）=0.24，95%置信区间（CI）=0.12 - 0.48，p<0.0001]。次要结局中，PPOS方案组的子宫内膜厚度与GnRH-A组相比有所降低（平均差值（MD）=-1.13，95%CI=-1.76至-0.51，p=0.0004）。在HOR亚组中，PPOS方案组的促性腺激素（Gn）剂量（MD=222.88，95%CI=59.30 - 386.46，p=0.008）和使用时间（MD=0.70，95%CI=0.48 - 0.92，p<0.00001）均高于GnRH-A方案组。在正常卵巢反应（NOR）亚组中，PPOS方案组的可移植胚胎数多于GnRH-A组（MD=2.00，95%CI=0.10 - 3.90，p=0.04）。
PPOS方案与GnRH-A方案具有相似的临床效果。在HOR患者中，PPOS方案组的Gn使用时间和剂量增加，而OHSS发生率降低。同时，在NOR患者中，PPOS方案组的可移植胚胎数增加。当患者因自身情况不选择进行新鲜胚胎移植时，PPOS方案可在临床实践中广泛推广。
