Effects of Different Endometrial Preparation Protocols on Pregnancy Outcomes in Women with Polycystic Ovarian Syndrome Undergoing Frozen Embryo Transfer: A Network Meta-Analysis.

IF 2.3 4区医学 Q2 OBSTETRICS & GYNECOLOGY

Gynecologic and Obstetric Investigation Pub Date : 2025-08-28 DOI:10.1159/000547119

MeiFang Zeng, Hailing Jiang, Baoping Zhu, JinLiang Duan

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引用次数: 0

Abstract

Aim: This study aimed to investigate the impact of various endometrial preparation protocols on pregnancy outcomes in women with polycystic ovarian syndrome (PCOS) undergoing frozen embryo transfer (FET).

Method: We conducted a comprehensive search of electronic databases, including PubMed, Embase, and the Cochrane Library, from their inception until February 2024 to identify relevant studies. The network meta-analysis (NMA) was performed using STATA 14.0 software.

Results: Seventeen studies met the inclusion criteria, encompassing 16,082 FET cycles (four randomized controlled trials and thirteen observational studies). Women with PCOS undergoing FET using the gonadotropin-releasing hormone agonist (GnRH-a) + hormone replacement therapy (HRT) protocol demonstrated a higher clinical pregnancy rate (CPR) compared to those using HRT alone (OR 1.50, 95% CI: 1.13-1.99). No significant differences were observed in the ongoing pregnancy rate (OPR) and ectopic pregnancy rate among the four examined endometrial preparation protocols (human menopausal gonadotropin [HMG]/follicle-stimulating hormone [FSH], letrozole [LE], HRT, and GnRH-a + HRT). Regarding the miscarriage rate (MR), the LE ovulation induction protocol exhibited a lower MR than the HRT protocol (OR 0.59, 95% CI: 0.46-0.74). The surface under the cumulative ranking curve indicated that the GnRH-a + HRT protocol was the most effective for the CPR. In contrast, the LE ovulation induction protocol was the most effective for minimizing the MR.

Conclusion: Our NMA suggests that the GnRH-a + HRT protocol results in a higher CPR compared to the HRT protocol in PCOS women undergoing FET, albeit with a higher risk of miscarriage. While offering comparable CPRs and OPRs to the GnRH-a + HRT protocol, the LE ovulation induction protocol presents a lower MR than the other endometrial preparation protocols.

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不同子宫内膜制备方案对冷冻胚胎移植多囊卵巢综合征患者妊娠结局的影响：一项网络荟萃分析

目的：本研究旨在探讨不同子宫内膜准备方案对冷冻胚胎移植（FET）多囊卵巢综合征（PCOS）患者妊娠结局的影响。方法：我们对PubMed、EMBASE和Cochrane Library等电子数据库进行了全面的检索，从其建立到2024年2月，以确定相关研究。采用STATA 14.0软件进行网络meta分析（NMA）。结果：17项研究符合纳入标准，包括16082个FET周期（4个随机对照试验和13个观察性研究）。PCOS患者接受FET时，使用促性腺激素释放激素激动剂(GnRH-a) +激素替代疗法（HRT）方案的临床妊娠率（CPR）高于单独使用HRT的患者（OR 1.50, 95% CI 1.13-1.99）。四种子宫内膜准备方案（人绝经期促性腺激素[HMG]/促卵泡激素[FSH]、来曲唑[LE]、HRT和GnRH-a + HRT）的持续妊娠率（OPR）和异位妊娠率（EPR）无显著差异。关于流产率（MR）， LE促排卵方案的MR低于HRT方案（OR 0.59, 95% CI 0.46-0.74）。累积排序曲线下曲面（SUCRA）显示GnRH-a + HRT方案对CPR最有效。相比之下，LE促排卵方案对最小化mr最有效。结论：我们的NMA表明，在接受FET的PCOS妇女中，GnRH-a + HRT方案的CPR比HRT方案高，尽管流产风险更高。虽然提供与GnRH-a + HRT方案相当的cpr和opr，但LE促排卵方案的MR低于其他子宫内膜准备方案。

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来源期刊

Gynecologic and Obstetric Investigation 医学-妇产科学

CiteScore

4.20

自引率

4.80%

发文量

审稿时长

6-12 weeks

期刊介绍： This journal covers the most active and promising areas of current research in gynecology and obstetrics. Invited, well-referenced reviews by noted experts keep readers in touch with the general framework and direction of international study. Original papers report selected experimental and clinical investigations in all fields related to gynecology, obstetrics and reproduction. Short communications are published to allow immediate discussion of new data. The international and interdisciplinary character of this periodical provides an avenue to less accessible sources and to worldwide research for investigators and practitioners.