在试管婴儿治疗中触发正常反应者的卵母细胞成熟:系统综述和网络荟萃分析。

IF 6.6 1区 医学 Q1 OBSTETRICS & GYNECOLOGY
Yusuf Beebeejaun, Timothy Copeland, James M N Duffy, Ippokratis Sarris, Marian Showell, Rui Wang, Sesh K Sunkara
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引用次数: 0

摘要

目的比较hCG、GnRH激动剂、双触发器和双触发器对接受卵巢刺激和试管婴儿的预测正常反应者的疗效和安全性 设计:随机对照试验(RCT)的系统综述和网络荟萃分析:截至 2023 年 12 月,PubMed、MEDLINE、EMBASE、临床试验登记处和 Cochrane 系统综述数据库收录的 RCT:共纳入了12项高整合性RCT,包括1931名女性,比较了hCG触发与GnRH激动剂触发、双触发和双触发。统计分析采用 STATA 16 版本:主要结果包括临床妊娠率(CPR)、活产率(LBR)、卵母细胞数、成熟卵母细胞数、流产率和卵巢过度刺激综合征(OHSS)发生率:网络荟萃分析结果显示,hCG与GnRH激动剂触发的CPR相对风险(RR)为1.13(95%置信区间(CI):0.80-1.60),hCG与双重触发的CPR相对风险(RR)为1.23(95%CI:0.92-1.65),hCG与GnRH激动剂触发的CPR相对风险(RR)为0.38(95%CI:0.21-0.69)。GnRH激动剂与双触发的RR为1.09(95% CI:0.70-1.70),GnRH激动剂与双触发的RR为0.34(95% CI:0.17-0.67),双触发与双触发的RR为0.31(95%CI:0.16-0.60)。双触发的 SUCRA 最高(85.1%),表明其在临床妊娠率方面具有更好的疗效。对于 LBR,虽然连通性有限,但双触发与 hCG 触发相比,RR 为 1.31(95% CI:1.00-1.70);双触发与 GnRH 激动剂触发相比,RR 为 1.60(95% CI:1.05-2.43)。GnRH激动剂触发的OHSS率明显低于hCG触发(RR 0.56,95% CI:0.19-1.75)。没有随机对照试验报告使用双触发或双触发时的OHSS发生率。各种触发方案在取卵数量、成熟卵母细胞或流产率方面均无明显差异:研究结果表明,没有证据表明使用 GnRH 促效剂、双重或双重方案在提高临床妊娠率方面优于 hCG 触发方案。虽然活产率可能得益于双重触发,但现有的 RCT 结果有限。为了进一步评估活产率和了解长期结果,需要进行更大规模的多中心试验。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Triggering oocyte maturation in in vitro fertilization treatment in healthy responders: a systematic review and network meta-analysis.

Objective: To compare efficacy and safety of human chorionic gonadotropin (hCG), gonadotropin-releasing hormone (GnRH) agonist, dual, and double triggers in predicted healthy responders undergoing ovarian stimulation and in vitro fertilization.

Design: A systematic review and network meta-analysis of randomized controlled trials (RCTs).

Data sources: Randomized controlled trials indexed in PubMed, MEDLINE, EMBASE, clinical trial registries, and Cochrane Database of Systematic Reviews up to December 2023.

Study selection and synthesis: Twelve high-integrity RCTs comprising 1,931 women were included, which compared hCG trigger with GnRH agonist trigger, dual trigger, and double trigger. Statistical analysis was performed using STATA version 16.

Main outcome measures: Key outcomes included clinical pregnancy rates (CPR), live birth rates (LBR), number of oocytes, number of mature oocytes, miscarriage rates, and rates of ovarian hyperstimulation syndrome.

Results: The network meta-analysis for CPR were risk ratio (RR), 1.13; (95% confidence interval [CI], 0.80-1.60) for hCG vs. GnRH agonist trigger, RR, 1.23 (95% CI, 0.92-1.65) for hCG vs. dual trigger, RR, 0.38 (95% CI, 0.21-0.69) for hCG vs. double trigger, RR, 1.09 (95% CI, 0.70-1.70) for GnRH agonist vs. dual trigger and 0.34 (95% CI, 0.17-0.67) for GnRH agonist vs. double trigger, and RR, 0.31 (95% CI, 0.16-0.60) for double vs. dual trigger. Dual trigger demonstrated the highest Surface Under the Cumulative Ranking (85.1%), indicating superior efficacy for CPR. For LBR, although connectivity was limited, the RR was 1.31 (95% CI, 1.00-1.70) for dual vs. hCG trigger, and RR, 1.60 (95% CI, 1.05-2.43) for dual vs. GnRH agonist trigger. Ovarian hyperstimulation syndrome rates were significantly lower with the GnRH agonist compared with hCG trigger (RR, 0.56; 95% CI, 0.19-1.75). There were no RCTs reporting ovarian hyperstimulation syndrome rates with the use of dual or double trigger. No significant differences were observed in the number of oocytes retrieved, mature oocytes, or miscarriage rates among the trigger protocols.

Conclusion and relevance: The findings indicate that there is no evidence to suggest that using GnRH agonist, dual, or double protocols is superior to hCG trigger in improving CPR. Although LBR may benefit from dual trigger, results are limited by available RCTs. Larger, multicenter trials are needed for further evaluation of LBR and understanding of long-term outcomes.

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来源期刊
Fertility and sterility
Fertility and sterility 医学-妇产科学
CiteScore
11.30
自引率
6.00%
发文量
1446
审稿时长
31 days
期刊介绍: Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders. The journal publishes juried original scientific articles in clinical and laboratory research relevant to reproductive endocrinology, urology, andrology, physiology, immunology, genetics, contraception, and menopause. Fertility and Sterility® encourages and supports meaningful basic and clinical research, and facilitates and promotes excellence in professional education, in the field of reproductive medicine.
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