GnRH-a联合GnRH-ant超短方案对卵巢低反应患者疗效的Meta分析

Effectiveness of ultrashort flare GnRH-agonist combined with GnRH-antagonist protocol in women with poor ovarian response: a meta-analysis

目的系统评价促性腺激素释放激素激动剂(GnRH-agonist,GnRH-a)联合促性腺激素释放激素拮抗剂(GnRH-antagonist,GnRH-ant)超短方案对卵巢低反应患者治疗的有效性。方法检索MEDLINE、EMBASE、CENTRAL、中国生物医学数据库和万方数据库,检索时间截至2017年7月。纳入关于GnRH-a联合GnRH-ant超短方案治疗卵巢低反应患者的随机对照试验或临床对照试验,由2位评价员根据纳入与排除标准独立进行文献筛选、资料提取和质量评价后,采用Rev Man 5.3软件进行Meta分析。结果共纳入6篇文献,336个周期;GnRH-a联合GnRH-ant超短方案与对照组比较,Gn用药总量(WMD=6.32,P=0.09,95%CI:-0.92~13.55)、Gn用药时间(WMD=0.38,P=0.07,95%CI:-0.04~0.81)、胚胎移植数(WMD=0.24,P=0.49,95%CI:-0.44~0.91)方面差异无统计学意义,其获卵数(WMD=0.29,P=0.40,95%CI:-0.38~0.96)、受精率(WMD=4.39,P=0.21,95%CI:-2.41~11.18)、临床妊娠率(OR=1.72,P=0.38,95%CI:0.52~5.71)较对照组稍升高,但差异均无统计学意义。结论 GnRH-a联合GnRH-ant超短方案对卵巢低反应患者的疗效与对照组促排卵方案比较无明显差异,且在获卵数、受精率、临床妊娠率上稍优于其他促排卵方案。

Objective To evaluate the therapeutic effect of ultrashort flare GnRH-agonist combined with GnRH-antagonist protocol in women with poor ovarian response. Methods We searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials （CENTRAL）, the Chinese Biomedicine （CBM） Database, and Wanfang Database for eligible studies published by the end of July, 2017. Two independent evaluators screened the randomized controlled trials and clinical controlled trails retrieved that compared the effects of ultrashort flare GnRH-agonist combined with GnRH-antagonist protocol with the control protocol in women with poor ovarian response. The quality of the included studies was assessed and data were extracted for meta-analysis using RevMan 5.3. Results Six studies with a total of 336 cycles were included in the final analysis. No significant differences were found between ultrashort flare GnRH-agonist combined with GnRH-antagonist protocol group and the control group in the number of gonadotropin ampules （WMD = 6.32, P =0.09, 95%CI： -0.92 - 13.55） , length of stimulation （WMD =0.38, P =0.07, 95% CI： -0.04 0.81 ） or the number of embryos transferred （WMD = 0.24, P = 0.49, 95% CI： - 0.44 - 0.91 ）. Ultrashort flare GnRH-agonist combined with GnRH-antagonist protocol resulted in a greater number of oocytcs retrieved （ WMD = 0.29, P = 0.40, 95% CI： - 0. 38 - 0.96） and higher fertilization rate （ WMD = 4.39, P = 0.21,95% CI： - 2.41 - 11.18） and clinical pregnancy rate （ OR = 1.72, P = 0.38, 95% CI： 0. 52 - 5.71 ） than the control protocol, but the differences were not statistically significant. Conclusion The currently available evidence suggests that ultrashort flare GnRH-agonist combined with GnRH-antagonist protocol is not inferior to other controlled ovarian hyperstimulation protocols, but this conclusion still awaits further verification by largescale randomised controlled trials.