Comparisons of GnRH antagonist protocol versus GnRH agonist long protocol in patients with normal ovarian reserve: A systematic review and meta-analysisReportar como inadecuado




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Objective

To evaluate the effectiveness and safety of gonadotropin-releasing hormone antagonist GnRH-ant protocol and gonadotropin-releasing hormone agonist GnRH-a long protocol in patients with normal ovarian reserve.

Methods

We searched the PubMed 1992–2016, Cochrane Library 1999–2016, Web of Science 1950–2016, Chinese Biomedical Database CBM, 1979–2016, and China National Knowledge Infrastructure CNKI, 1994–2016. Any randomized controlled trials RCTs that compared GnRH-ant protocol and GnRH-a long protocol in patients with normal ovarian reserve were included, and data were extracted independently by two reviewers. The meta-analysis was performed by Revman 5.3 software.

Results

Twenty-nine RCTs 6399 patients were included in this meta-analysis. Stimulation days mean difference MD 95% confidence interval CI = -0.8 -1.36 -0.23, P = 0.006, gonadotrophin Gn dosage MD 95% CI = -3.52 -5.56 -1.48, P = 0.0007, estradiol E2 level on the day of human chorionic gonadotrophin HCG administration MD 95% CI = -365.49 -532.93 -198.05, P<0.0001, the number of oocytes retrieved MD 95% CI = -1.41 -1.84 -0.99, P<0.00001, the embryos obtained MD 95% CI = -0.99 -1.38 -0.59, P<0.00001, incidence of ovarian hyperstimulation syndrome OHSS OR 95% CI = 0.69 0.57, 0.83, P<0.0001 were statistically significantly lower in GnRH-ant protocol than GnRH-a long protocol. However, the clinical pregnancy rate OR 95% CI = 0.90 0.80, 1.01, P = 0.08, ongoing pregnancy rate OR 95% CI = 0.88 0.77, 1.00, P = 0.05, live birth rate OR 95% CI = 0.95 0.74, 1.09, P = 0.27, miscarriage rate OR 95% CI = 0.98 0.69, 1.40, P = 0.93, and cycle cancellation rate OR 95% CI = 0.86 0.52, 1.44, P = 0.57 showed no significant differences between the two groups.

Conclusion

GnRH-ant protocol substantially decreased the incidence of OHSS without influencing the pregnancy rate and live birth rate compared to GnRH-a long protocol among patients with normal ovarian reserve.



Autor: Ruolin Wang, Shouren Lin, Yong Wang, Weiping Qian , Liang Zhou

Fuente: http://plos.srce.hr/



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