Comparison of the clinical efficacy of progestin-primed ovarian stimulation protocol and antagonist protocol in patients with poor ovarian response: a meta-analysis
10.3760/cma.j.cn101441-20201021-00573
- VernacularTitle:卵巢低反应患者高孕激素状态下促排卵方案与拮抗剂方案临床应用效果对比的meta分析
- Author:
Xin YANG
1
;
Jinlong CAO
;
Huijuan PAN
;
Chunfang ZHANG
;
Xiaofeng LI
;
Fang WANG
Author Information
1. 兰州大学第二医院生殖医学中心，兰州 730030
- Publication Type:Journal Article
- Keywords:
Progestin-primed ovarian stimulation;
Gonadotropin-releasing hormone-antagonist;
Controlled ovulation stimulation;
Poor ovarian response;
Meta-analysis
- From:
Chinese Journal of Reproduction and Contraception
2022;42(4):379-387
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To compare the clinical efficacy of progestin-primed ovarian stimulation (PPOS) protocol and gonadotropin-releasing hormone (GnRH)-antagonist protocol in patients with poor ovarian response (POR).Methods:By retrieving Pubmed, the Cochrane Library, Embase, Web of Science, CNKI, Wanfang Data, and CBM databases, the cohort studies and randomized controlled trials (RCTs) of PPOS and antagonist protocols applied to POR patients were collect and the retrieval time period was from establishment of the database to May 2020. After rigorous literature screening and data extraction, the cohort study used Newcastle Ottawa Scale (NOS) system evaluation method, the RCT used Cochrane system evaluation method to evaluate the literature quality, and the RevMan5.3 software was used for meta-analysis.Results:A total of 7 cohort studies and 3 RCTs were included, totally 1977 POR patients, including 1053 in the PPOS protocol group and 924 in the antagonist protocol. Meta-analysis showed that the duration of gonadotropin (Gn) used in PPOS protocol group was extended ( P=0.02), but there was no significant difference in the total dosage of Gn used compared with the antagonist protocol ( P>0.05). There were no significant differences in the number of follicles with a diameter ≥14 mm and the number of retrieved oocytes between PPOS protocol group and antagonist protocol group (all P>0.05), the M Ⅱ oocyte rate and the fertilization rate were significantly higher than those of antagonist protocol ( P=0.04, P<0.001), but there were no significant differences in the rate of high-quality embryos between the two groups ( P>0.05). The incidence of early onset luteinizing hormone (LH) peak significantly reduced with PPOS protocol ( P=0.04), the levels of estrogen, progesterone, follicle-stimulating hormone (FSH) and LH on trigger day were not significantly different from those of antagonist protocol (all P>0.05). The clinical pregnancy rate of PPOS protocol was higher than that of the antagonist protocol, but the abortion rate was lower than that of the antagonist protocol ( P=0.03, P<0.001), and there were no significant differences in cycle cancellation rate and birth rate between the two protocols ( P>0.05). Conclusion:PPOS protocol can significantly reduce the incidence of premature LH surge in ovulation induction in POR patients, increase the M Ⅱ oocytes rate, improve the pregnancy outcome, reduce the incidence of adverse pregnancy, and can be widely and safely used in POR patients.
