GnRH激动剂在人工周期冻融胚胎移植黄体支持中作用的荟萃分析

Meta-analysis of the role of GnRH agonist for luteal phase support in artificial cycle frozen-thawed embryo transfers

目的:评价GnRH激动剂(GnRH-a)在人工周期冻融胚胎移植(AC-FET)黄体期支持(LPS)中的作用。方法:纳入PubMed、EMBASE和Cochrane数据库中符合纳入标准的研究。检索期限为建库至2023年10月31日。观察指标为种植率、HCG阳性率、临床妊娠率、持续妊娠率、活产率、流产率、宫外妊娠率、多胎妊娠率。采用RevMan5.4软件分析。结果:纳入9项随机对照试验(RCT),共2451例患者,其中GnRH-a LPS组1252例,常规LPS组1199例。黄体期给予GnRH-a可提高种植率(OR=1.29,95%CI为1.12~1.49,P=0.0005)、临床妊娠率(OR=1.32,95%CI为1.12~1.57,P=0.001)和多胎妊娠率(OR=1.82,95%CI为1.29~2.58,P=0.0007),同时降低流产率(OR=0.57,95%CI为0.41~0.79,P=0.0008)。两组的HCG阳性率、持续妊娠率、活产率、宫外妊娠率比较,差异均无统计学意义。结论:AC-FET黄体期添加GnRH-a可提高患者的种植率和临床妊娠率,提示GnRH-a可能是AC-FET黄体支持的新选择。然而,需开展多中心、大样本的RCT,以获得GnRH-a有效黄体支持的统一标准,进一步明确其LPS的安全性和有效性。

Objective:To evaluate the effect of GnRH agonist(GnRH-a)for luteal phase support(LPS)in artificial cycle frozen-thawed embryo transfers(AC-FETs).Methods:Eligible studies were identified from PubMed,EMBASE,and the Cochrane Library before October 31,2023.Outcome measures were the implantation rate,positive HCG rate,clinical pregnancy rate,ongoing pregnancy rate,live birth rate,miscarriage rate,extrauterine pregnancy rate,and multiple pregnancy rate.RevMan 5.4 software was utilized for analysis.Results:In total,nine RCTs were eligible for analysis.Of the total of 2451 patients,1252 cases were in the GnRH-a LPS group,and 1199 cases were in the conventional LPS group.The present results showed that administration of GnRH-a in the luteal phase increased the implantation rate(OR=1.29,95%CI:1.12~1.49,P=0.0005),clinical pregnancy rate(OR=1.32,95%CI:1.12~1.57,P=0.001),and multiple pregnancy rate(OR=1.82,95%CI:1.29~2.58,P=0.0007),reduced the miscarriage rate(OR=0.57,95%CI:0.41~0.79,P=0.0008).However,there were no differences in the positive HCG rate,ongoing pregnancy rate,live birth rate or extrauterine pregnancy rate between the two groups.Conclusion:The addition of GnRH-a in the luteal phase during AC-FET improves the embryo implantation rate and clinical pregnancy rate,indicating that GnRH-a treatment may be new option for luteal support in AC-FET.However,a multicenter,large sample RCT needs to be conducted to obtain a unified standard of effective luteal support for GnRH-a and to further clarify the safety and effectiveness of GnRH-a luteal support.