Min Wang, Lianwen Zheng, Shuai Ma, Ying Xu, Jingshun Zhang, Lulu Fu
{"title":"黄体酮刺激卵巢方案和促性腺激素释放激素拮抗剂方案在辅助生殖技术中的效果比较：系统综述和荟萃分析。","authors":"Min Wang, Lianwen Zheng, Shuai Ma, Ying Xu, Jingshun Zhang, Lulu Fu","doi":"10.1007/s10815-025-03612-4","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>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).</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":15246,"journal":{"name":"Journal of Assisted Reproduction and Genetics","volume":" ","pages":""},"PeriodicalIF":2.7000,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"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.\",\"authors\":\"Min Wang, Lianwen Zheng, Shuai Ma, Ying Xu, Jingshun Zhang, Lulu Fu\",\"doi\":\"10.1007/s10815-025-03612-4\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>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).</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusion: </strong>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.</p>\",\"PeriodicalId\":15246,\"journal\":{\"name\":\"Journal of Assisted Reproduction and Genetics\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":2.7000,\"publicationDate\":\"2025-08-07\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Assisted Reproduction and Genetics\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1007/s10815-025-03612-4\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"GENETICS & HEREDITY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Assisted Reproduction and Genetics","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s10815-025-03612-4","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"GENETICS & HEREDITY","Score":null,"Total":0}
引用次数: 0
摘要
目的：比较孕激素刺激卵巢（PPOS）方案和促性腺激素释放激素拮抗剂（GnRH-A）方案对不同卵巢储备接受辅助生殖技术（ART）的女性的影响。方法：我们在Cochrane图书馆、Web of Science、Embase、PubMed、CNKI和CBM数据库中检索已发表的研究。实验组采用PPOS方案，对照组采用GnRH-A方案。收集PPOS和GnRH-A方案的随机对照试验（rct）和非随机对照试验（n- rct）。我们检索了2024年11月1日之前发表的文献。对不同卵巢储备的患者进行亚组分析。结果：本研究共纳入36项研究。主要结果显示，PPOS组和GnRH-A组的活产率相似。在高卵巢反应（HOR）患者中，PPOS方案组卵巢过度刺激综合征（OHSS）的发生率明显低于GnRH-A组[OR = 0.24, 95%可信区间(CI) = 0.12-0.48, p]。结论：PPOS方案与GnRH-A方案具有相似的临床效果。在HOR患者中，PPOS方案组的Gn持续时间和剂量增加，而OHSS发生率降低。同时，在NOR患者中，PPOS方案组的活胚数量增加。当患者因自身情况不选择进行新鲜胚胎移植时，PPOS方案可以在临床实践中广泛推广。
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.
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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