高孕激素状态下促排卵方案在PCOS患者IVF-ET临床疗效的Meta分析

Clinical efficacy of progesterone-primed ovarian stimulation in IVF-ET for patients with PCOS:a meta-analysis

目的探讨高孕激素状态下促排卵方案(PPOS)在PCOS患者行IVF-ET中促排卵的有效性与安全性。方法计算机检索PubMed、Embase、Cochrane library、Web of Science、中国知网、维普数据库,检索时间为2015年1月至2021年4月,检索关于PCOS患者行IVF时使用PPOS方案和其他常规方案促排卵的随机对照研究和临床对照研究,按照本研究指定的纳入和排除标准进行文献筛选,对纳入的研究进行数据提取和质量评价后,利用Stata软件进行Meta分析。结果本研究纳入11篇文献共1891例PCOS患者,其中PPOS组948个周期,其他常规促排卵方案组943个周期。Meta分析结果显示:PPOS方案与其他常规促排卵方案相比,可显著降低PCOS患者促排卵中早发LH峰的发生率[RR=0.39,95%CI(0.16,0.92),P=0.03]和OHSS发生率[RR=0.45,95%CI(0.26,0.75),P<0.01],但两组间临床妊娠率无显著性差异[RR=1.08,95%CI(0.97,1.20),P=0.15]。不同方案亚组分析结果显示:相对于拮抗剂方案,PPOS方案的早发LH峰发生率显著降低[RR=0.34,95%CI(0.13,0.86),P=0.02],OHSS发生风险显著减少[RR=0.27,95%CI(0.11,0.69),P=0.01],但临床妊娠率相当[RR=0.96,95%CI(0.81,1.13),P=0.27];相对于长方案,PPOS方案的早发LH峰发生率、OHSS发生率、临床妊娠率均无显著差异(P>0.05);相对于短方案,PPOS方案的临床妊娠率显著升高[RR=1.27,95%CI(1.06,1.52),P=0.01],但早发LH峰发生率和OHSS发生率均无显著差异(P>0.05)。结论对于PCOS患者,PPOS方案可获得与其他常规促排卵方案相似的临床效果;相对于拮抗剂方案,PPOS方案的临床妊娠率相当,但能更好地降低早发LH峰发生率和OHSS发生风险,并且更经济、灵活。

Objective:To investigate the clinical effectiveness of progesterone-primed ovarian stimulation(PPOS)protocol in IVF-ET for patients with polycystic ovarian syndrome(PCOS).Methods:PubMed,Embase,Cochrane library,Web of Science,CNKI and VIP databases were electronically searched for the randomized controlled study and clinical controlled study on ovulation induction with PPOS protocol or the conventional controlled ovarian stimulation(COS)protocol in patients with PCOS undergone IVF from January 2015 to April 2021.The literature screening was carried out according to the inclusion and exclusion criteria specified in this study.After data extraction and quality evaluation of the included studies,meta-analysis was carried out by Stata software.Results:Eleven literatures including 1891 cycles were included in the meta-analysis.There were 948 cycles with PPOS protocol and 943 cycles with conventional COS protocols.The meta-analysis showed that PPOS protocol decreased the incidence of premature LH surge[RR=0.39,95%CI(0.16,0.92),P=0.03]and OHSS[RR=0.45,95%CI(0.26,0.75),P<0.01],while the clinical pregnancy rate was not significantly different with conventional COS protocols[RR=1.08,95%CI(0.97,1.20),P=0.15].In the subgroup comparing with GnRH-antagonist protocol,PPOS protocol decreased the incidence of premature LH surge[RR=0.34,95%CI(0.13,0.86),P=0.02]and OHSS[RR=0.27,95%CI(0.11,0.69),P=0.01],while the clinical pregnancy rate was not significantly different[RR=0.96,95%CI(0.81,1.13),P=0.27].In the subgroup comparing with long protocol,there were no differences in the incidence of premature LH surge&OHSS and the clinical pregnancy rate(P>0.05).In the subgroup comparing with short protocol,there were no differences in the rate of premature LH surge or the rate of OHSS(P>0.05),but the clinical pregnancy rate was significantly higher in the PPOS protocol[RR=1.27,95%CI(1.06,1.52),P=0.01].Conclusions:There was no significant difference in clinical efficacy between PPOS protocol and conventional COS protocols in PCOS patients.PPOS protocol can obtain similar clinical outcomes to those of conventional COS protocol in PCOS patients.Compared with GnRH-antagonist protocol,PPOS protocol has the similar clinical pregnancy rate,but it can better reduce the incidence of e premature LH surge and the risk of OHSS,and is more economical and flexible.