人類生殖 (生殖期刊第二名)。 2011年7月21日。 搶鮮版
比較GnRH拮抗劑與 GnRH促進劑用於卵巢反應不佳者接受試管治療的結果
中華人民共和國的研究
摘要
背景
比較GnRH拮抗劑與 GnRH促進劑用於卵巢反應不佳者接受試管治療的結果
方法
我們檢索所有發表的文章編入MEDLINE（2050至10年），EMBASE（1974年至2010年）和中國國家知識基礎設施（CNKI，1994-2010）。數據分析由兩名獨立評審任何隨機對照研究，比較GnRH拮抗劑與 GnRH促進劑用於卵巢反應不佳者接受試管治療IVF / ICSI被包括在內。這次搜索64篇相關論文，從其中14篇相關論文符合標準。進行這項綜整分析，涉及566例試管嬰兒在GnRH拮抗劑組和561例患者為促性腺激素釋放激素(GnRH)促進劑組，審查管理器4.2軟件。比值比（OR）和加權均數差（WMD）及其95％可信區間（CI）被用來評估二分和連續的數據，分別為。結果十四個符合條件的研究，包括在本綜整分析分析。GnRH拮抗劑比GnRH促進劑了統計上顯著的較短的刺激排卵時間，（P = 0.04; WMD：-1.88，95％CI：-3.64，-0.12），但在數卵母細胞中檢索（P = 0.51; WMD：-0.17，95％CI -0.69，0.34）或成熟的卵母細胞的數量檢索（P = 0.99; WMD：-0.01，95％CI：-1.14，1.12）無顯著差異，。此外發現兩者在週期取消率（CCR，P = 0.67，OR：1.01，95％CI：0.71-1.42）或臨床妊娠率（CPR，P = 0.16，OR：1.23，95％CI： 0.92，1.66），無顯著差異，。結論是GnRH拮抗劑的使用對卵巢反應不佳接受試管受精明顯的優勢是顯著的較短的刺激排卵時間。然而GnRH拮抗劑與GnRH促進劑之間取卵數，成熟卵數，週期取消率及臨床懷孕率沒有統計學差異。這些結果可能有助於我們的臨床操作。然而，進一步控制隨機前瞻性研究具有較大的樣本量是必要的。
PS: 僅管這篇的結論顯示GnRH拮抗劑與GnRH促進劑之間取卵數，成熟卵數，週期取消率及臨床懷孕率沒有統計學差異。多數的研究，研討會或經驗法則仍傾向卵巢反應不佳者接受試管治療不favor GnRH促進劑為主的長療程，怕卵巢壓抑過度導至用藥過重，引卵時間過長 。
Hum Reprod. 2011 Jul 21. [Epub ahead of print]
Comparisons of GnRH antagonist versus GnRH agonist protocol in poor ovarian responders undergoing IVF.
Source
Department of Obstetrics and Gynecology, The First Affiliated Hospital of Nanjing Medical University, 210029 Nanjing, People's Republic of China.
Abstract
BACKGROUND In view of the discrepancies about the GnRH antagonist (GnRH-ant) ovarian stimulation protocols having some potential advantages compared with the GnRH agonist (GnRH-a) protocols in poor ovarian responders IVF/ICSI, a meta-analysis of the published data was performed to compare the efficacy of GnRH-ant versus GnRH-a protocols for ovarian stimulation in IVF poor response patients. METHODS We searched for all published articles indexed in MEDLINE (1950-2010), EMBASE (1974-2010) and China National Knowledge Infrastructure (CNKI, 1994-2010). Any randomized controlled study that compared the GnRH-ant with GnRH-a in ovarian stimulation protocols for poor responders undergoing IVF/ICSI was included, and data were extracted independently by two reviewers. The searches yielded 64 articles, from which 14 studies met the inclusion criteria. We performed this meta-analysis involving 566 IVF patients in a GnRH-ant protocol group and 561 patients in a GnRH-a protocol group with Review Manager 4.2 software. Odds ratio (OR) and weighted mean difference (WMD) with 95% confidence intervals (CIs) were used to evaluate dichotomous and continuous data, respectively. RESULTS Fourteen eligible studies were included in this meta-analysis. GnRH-ant protocols resulted in a statistically significantly lower duration of stimulation compared with GnRH-a protocols (P = 0.04; WMD: -1.88, 95% CI: -3.64, -0.12), but there was no significant difference in the number of oocytes retrieved (P = 0.51; WMD: -0.17, 95% CI -0.69, 0.34) or the number of mature oocytes retrieved (P = 0.99; WMD: -0.01, 95% CI: -1.14, 1.12). Moreover, no significant difference was found in the cycle cancellation rate (CCR, P = 0.67; OR: 1.01, 95% CI: 0.71-1.42) or clinical pregnancy rate (CPR, P = 0.16; OR: 1.23, 95% CI: 0.92, 1.66). CONCLUSIONS Clear advantage was gained in duration of stimulation with GnRH-ant in poor ovarian responders undergoing IVF, although there was no statistical difference in the number of oocytes retrieved, the number of mature oocytes retrieved, the CCR and CPR between GnRH-ant and GnRH-a protocols. These results may be helpful to our clinical practice. However, further controlled randomized prospective studies with larger sample sizes are needed.
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