A comparison of the effects of progestin-primed ovarian stimulation protocol and gonadotropin-releasing hormone antagonist protocol in assisted reproductive technology: a systematic review and meta-analysis.
Min Wang, Lianwen Zheng, Shuai Ma, Ying Xu, Jingshun Zhang, Lulu Fu
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引用次数: 0
Abstract
Objective: 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).
Methods: 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.
Results: 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).
Conclusion: 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.
期刊介绍：
The Journal of Assisted Reproduction and Genetics publishes cellular, molecular, genetic, and epigenetic discoveries advancing our understanding of the biology and underlying mechanisms from gametogenesis to offspring health. Special emphasis is placed on the practice and evolution of assisted reproduction technologies (ARTs) with reference to the diagnosis and management of diseases affecting fertility. Our goal is to educate our readership in the translation of basic and clinical discoveries made from human or relevant animal models to the safe and efficacious practice of human ARTs. The scientific rigor and ethical standards embraced by the JARG editorial team ensures a broad international base of expertise guiding the marriage of contemporary clinical research paradigms with basic science discovery. JARG publishes original papers, minireviews, case reports, and opinion pieces often combined into special topic issues that will educate clinicians and scientists with interests in the mechanisms of human development that bear on the treatment of infertility and emerging innovations in human ARTs. The guiding principles of male and female reproductive health impacting pre- and post-conceptional viability and developmental potential are emphasized within the purview of human reproductive health in current and future generations of our species.
The journal is published in cooperation with the American Society for Reproductive Medicine, an organization of more than 8,000 physicians, researchers, nurses, technicians and other professionals dedicated to advancing knowledge and expertise in reproductive biology.
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