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GnRH-a联合GnRH-ant超短方案对卵巢低反应患者疗效的Meta分析
Effectiveness of ultrashort flare GnRH-agonist combined with GnRH-antagonist protocol in women with poor ovarian response: a meta-analysis
- 第三军医大学学报 2018年40卷第4期 页码：350-355
- 作者机构：
400016 重庆，重庆医科大学附属第一医院生殖健康与不孕症专科Special Department of Reproductive Health and Infertility, First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
- 作者简介：
- 基金信息：
DOI：10.16016/j.1000-5404.201710039
中图分类号： R181.23; R711.6; R977.1收稿：2017-10-10，
纸质出版：2018-02-28
- 稿件说明：
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傅惠佳, 班艳娜, 刘西茹. GnRH-a联合GnRH-ant超短方案对卵巢低反应患者疗效的Meta分析[J]. 第三军医大学学报, 2018,40(4):350-355.
Huijia FU, Yanna BAN, Xiru LIU. Effectiveness of ultrashort flare GnRH-agonist combined with GnRH-antagonist protocol in women with poor ovarian response: a meta-analysis[J]. Journal of Third Military Medical University, 2018, 40(4): 350-355.
傅惠佳, 班艳娜, 刘西茹. GnRH-a联合GnRH-ant超短方案对卵巢低反应患者疗效的Meta分析[J]. 第三军医大学学报, 2018,40(4):350-355. DOI： 10.16016/j.1000-5404.201710039.
Huijia FU, Yanna BAN, Xiru LIU. Effectiveness of ultrashort flare GnRH-agonist combined with GnRH-antagonist protocol in women with poor ovarian response: a meta-analysis[J]. Journal of Third Military Medical University, 2018, 40(4): 350-355. DOI： 10.16016/j.1000-5404.201710039.
摘要
目的
2
系统评价促性腺激素释放激素激动剂(GnRH-agonist，GnRH-a)联合促性腺激素释放激素拮抗剂(GnRH-antagonist，GnRH-ant)超短方案对卵巢低反应患者治疗的有效性。
方法
2
检索MEDLINE、EMBASE、CENTRAL、中国生物医学数据库和万方数据库，检索时间截至2017年7月。纳入关于GnRH-a联合GnRH-ant超短方案治疗卵巢低反应患者的随机对照试验或临床对照试验，由2位评价员根据纳入与排除标准独立进行文献筛选、资料提取和质量评价后，采用RevMan 5.3软件进行Meta分析。
结果
2
共纳入6篇文献，336个周期；GnRH-a联合GnRH-ant超短方案与对照组比较，Gn用药总量(WMD=6.32，
P
=0.09，95%
CI
：-0.92~13.55)、Gn用药时间(WMD=0.38，
P
=0.07，95%
CI
：-0.04~0.81)、胚胎移植数(WMD=0.24，
P
=0.49，95%
CI
：-0.44~0.91)方面差异无统计学意义，其获卵数(WMD=0.29，
P
=0.40
95%
CI
：-0.38~0.96)、受精率(WMD=4.39，
P
=0.21
95%
CI
：-2.41~11.18)、临床妊娠率(
OR
=1.72，
P
=0.38
95%
CI
：0.52~5.71)较对照组稍升高，但差异均无统计学意义。
结论
2
GnRH-a联合GnRH-ant超短方案对卵巢低反应患者的疗效与对照组促排卵方案比较无明显差异，且在获卵数、受精率、临床妊娠率上稍优于其他促排卵方案。
Abstract
Objective
2
To evaluate the therapeutic effect of ultrashort flare GnRH-agonist combined with GnRH-antagonist protocol in women with poor ovarian response.
Methods
2
We searched MEDLINE
EMBASE
the Cochrane Central Register of Controlled Trials (CENTRAL)
the Chinese Biomedicine (CBM) Database
and Wanfang Database for eligible studies published by the end of July
2017. Two independent evaluators screened the randomized controlled trials and clinical controlled trails retrieved that compared the effects of ultrashort flare GnRH-agonist combined with GnRH-antagonist protocol with the control protocol in women with poor ovarian response. The quality of the included studies was assessed and data were extracted for meta-analysis using RevMan 5.3.
Results
2
Six studies with a total of 336 cycles were included in the final analysis. No significant differences were found between ultrashort flare GnRH-agonist combined with GnRH-antagonist protocol group and the control group in the number of gonadotropin ampules (WMD=6.32
P
=0.09
95%
CI
: -0.92~13.55)
length of stimulation (WMD=0.38
P
=0.07
95%
CI
: -0.04~0.81) or the number of embryos transferred (WMD=0.24
P
=0.49
95%
CI
: -0.44~0.91). Ultrashort flare GnRH-agonist
combined with GnRH-antagonist protocol resulted in a greater number of oocytes retrieved (WMD=0.29
P
=0.40
95%
CI
: -0.38~0.96) and higher fertilization rate (WMD=4.39
P
=0.21
95%
CI
: -2.41~11.18) and clinical pregnancy rate (OR=1.72
P
=0.38
95%
CI
: 0.52~5.71) than the control protocol
but the differences were not statistically significant.
Conclusion
2
The currently available evidence suggests that ultrashort flare GnRH-agonist combined with GnRH-antagonist protocol is not inferior to other controlled ovarian hyperstimulation protocols
but this conclusion still awaits further verification by large-scale randomised controlled trials.
关键词
Keywords
references
ZEGERS-HOCHSCHILD F, ADAMSON G D, DE MOUZON J, et al . International committee for monitoring assisted reproductive technology (ICMART) and the world health organization (WHO) revised glossary of ART terminology[J ] . Fertil Steril, 2009, 92(5): 1520-1524. DOI: 10.1016/j.fertnstert.2009.09.009.
PENZIAS A S. Improving results with assisted reproductive technologies: individualized patient-tailored strategies for ovulation induction[J]. Reprod Biomed Online, 2004, 9(1): 43-46. DOI: 10.1016/s1472-6483(10)62108-6.
LAMBALK C B, BANGA F R, HUIRNE J A, et al . GnRH antagonist versus long agonist protocols in IVF: a systematic review and meta-analysis accounting for patient type[J ] . Hum Reprod Update, 2017, 23(5): 560-579. DOI: 10.1093/humupd/dmx017.
ORVIETO R, PATRIZIO P. GnRH agonist versus GnRH antagonist in ovarian stimulation: an ongoingdebate[J]. Reprod Biomed Online, 2013, 26(1): 4-8. DOI: 10.1016/j.rbmo.2012.11.001.
ORVIETO R, LAUFER N. Ultrashort flare gonadotropin-releasing hormone (GnRH) agonist/GnRH antagonist protocol: a valuable tool in the armamentarium of ovulation induction for in vitro fertilization[J]. Fertil Steril, 2014, 102(5): 1254-1255. DOI: 10.1016/j.fertnstert.2014.09.003.
ORVIETO R, Kruchkovich J, Rabinson J, et al . Ultrashort gonadotropin-releasing hormone agonist combined with flexible multidose gonadotropin-releasing hormone antagonist for poor responders in in vitro fertilization/embryo transfer programs[J ] . Fertil Steril, 2008, 90(1): 228-230. DOI: 10.1016/j.fertnstert.2007.06.022.
ORVIETO R, NAHUM R, RABINSON J, et al . Ultrashort flare GnRH agonist combined with flexible multidose GnRH antagonist for patients with repeated IVF failures and poor embryo quality[J ] . Fertil Steril, 2009, 91(4 Suppl): 1398-1400. DOI: 10.1016/j.fertnstert.2008.04.064.
ORVIETO R, MELTCER S, LIBERTY G, et al . A combined approach to patients with repeated IVF failures[J ] . Fertil Steril, 2010, 94(6): 2462-2464. DOI: 10.1016/j.fertnstert.2010.03.057.
BERKER B, ILTEMIR DUVAN C, KAYA C, et al .Comparison of the ultrashort gonadotropin-releasing hormone agonist-antagonist protocol with microdose flare -up protocol in poor responders: a preliminary study[J ] . J Turk Ger Gynecol Assoc, 2010, 11(4): 187-193. DOI: 10.5152/jtgga.2010.35.
EFTEKHAR M, MOHAMMADIAN F, YOUSEFNEJAD F, et al . Microdose GnRH agonist flare-up versus ultrashort gnRH agonist combined with fixed GnRH antagonist in poor responders of assisted reproductive techniques cycles[J ] . Int J Fertil Steril, 2013, 6(4): 266-27 1.
ORVIETO R, NAHUM R, ZOHAV E, et al . GnRH-agonist ovulation trigger in patients undergoing controlled ovarian hyperstimulation for IVF with ultrashort flare GnRH-agonist combined with multidose GnRH-antagonist protocol[J ] . Gynecol Endocrinol, 2013, 29(1): 51-53. DOI: 10.3109/09513590.2012.705376.
GRIESINGER G, DIEDRICH K, TARLATZIS B C, et al . GnRH-antagonists in ovarian stimulation for IVF in patients with poor response to gonadotrophins, polycystic ovary syndrome, and risk of ovarian hyperstimulation: a meta-analysis[J ] . Reprod Biomed Online, 2006, 13(5): 628-638.
BEN-RAFAEL Z, LIPITZ S, BIDER D, et al . Ovarian hyporesponsiveness in combined gonadotropin-releasing hormone agonist and menotropin therapy is associated with low serum follicle-stimulating hormone levels[J ] . Fertil Steril, 1991, 55(2): 272-275. DOI: 10.1016/s0015-0282(16)54114-4.
SHEEHAN K L, CASPER R F, YEN S S. Induction of luteolysis by luteinizing hormone-releasing factor (LRF) agonist: sensitivity, reproducibility, and reversibility[J]. Fertil Steril, 1982, 37(2): 209-212.
MAHUTTE N G, Arici A. Role of gonadotropin-releasing hormone antagonists in poor responders[J]. Fertil Steril, 2007, 87(2): 241-249. DOI: 10.1016/j.fertnstert.2006.07.1457.
FASOULIOTIS S J, LAUFER N, SABBAGH-EHRLICH S, et al . Gonadotropin-releasing hormone (GnRH)-antagonist versus GnRH-agonist in ovarian stimulation of poor responders undergoing IVF[J ] . J Assist Reprod Genet, 2003, 20(11): 455-460. DOI: 10.1023/b:jarg.0000006707.88826.e7.
MALMUSI S, LA MARCA A, GIULINI S, et al . Comparison of a gonadotropin-releasing hormone (GnRH) antagonist and GnRH agonist flare-up regimen in poor responders undergoing ovarian stimulation[J ] . Fertil Steril, 2005, 84(2): 402-406. DOI: 10.1016/j.fertnstert.2005.01.139.
SCOTT R T, NAVOT D. Enhancement of ovarian responsiveness with microdoses of gonadotropin-releasing hormone agonist during ovulation induction for in vitro fertilization[J]. Fertil Steril, 1994, 61(5): 880-885. DOI: 10.1016/s0015-0282(16)56700-4.
SURREY E S, BOWER J, HILL D M, et al . Clinical and endocrine effects of a microdose GnRH agonist flare regimen administered to poor responders who are undergoing in vitro fertilization[J ] . Fertil Steril, 1998, 69(3): 419-424.
KAHRAMAN K, BERKER B, ATABEKOGLU C S, et al . Microdose gonadotropin-releasing hormone agonist flare-up protocol versus multiple dose gonadotropin-releasing hormone antagonist protocol in poor responders undergoing intracytoplasmic sperm injection-embryo transfer cycle[J ] . Fertil Steril, 2009, 91(6): 2437-2444. DOI: 10.1016/j.fertnstert.2008.03.057.
SIGHINOLFI G, GRISENDI V, LA MARCA A. How to personalize ovarian stimulation in clinical practice[J]. J Turk Ger Gynecol Assoc, 2017, 18(3): 148-153. DOI: 10.4274/jtgga.2017.0058.
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