Abstract：
OBJECTIVE: To conduct a systematic review andmeta-analysis of all randomized controlled trials (RCTs) that investigated whether dual triggering [a combination of gonadotropin-releasing hormone (GnRH) agonist and human chorionic gonadotropin (hCG)] of final oocyte maturation can improve the number of oocytes retrieved and clinical pregnancy rate in low or normal responders undergoing in-vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) cycles using a GnRH-antagonist protocol.
METHODS: Studies up to October 2022 were identified from PubMed, Scopus, Cochrane Library and Web of Science. The risk of bias of included studies was assessed. Dichotomous outcomes were reported as relative risks (RR), and continuous outcomes were reported as weighted mean differences (WMD) with 95% confidence intervals (CI). The primary outcomes were number of oocytes retrieved, number of mature [metaphase II (MII)] oocytes, clinical pregnancy rate and ongoing pregnancy rate; other IVF outcomes were considered as secondary outcomes.
RESULTS: Seven studies were identified, and 898 patients were eligible for inclusion in this meta-analysis. The results showed that the number of oocytes retrieved [WMD = 1.38 (95% CI 0.47-2.28), I2 = 66%, p = 0.003, low evidence], number of MII oocytes [WMD = 0.7 (95% CI 0.35-1.05), I2 = 42%, p < 0.0001, moderate evidence], number of embryos [WMD = 0.68 (95% CI 0.07-1.3), I2 = 67%, p = 0.03, low evidence] and number of good-quality embryos [WMD = 1.14 (95% CI 0.35-1.93), I2 = 0%, p = 0.005, moderate evidence] in the dual trigger group were significantly higher than in the hCG trigger group. The results of the ovarian response subgroup analysis showed significant differences in all of these outcomes in normal responders, and no differences in any of the outcomes in low responders, except for the number of MII oocytes. In low responders, clinical pregnancy rates may be improved in the dual trigger group [RR = 2.2 (95% CI 1.05-4.61), I2 = 28%, p = 0.04, low evidence].
CONCLUSIONS: Dual triggering by GnRH agonist and hCG improved oocyte maturity and embryo grading for normal responders in GnRH-antagonist cycles. Dual triggering for final oocyte maturation may improve clinical pregnancy rates in low responders.
METHODS: Studies up to October 2022 were identified from PubMed, Scopus, Cochrane Library and Web of Science. The risk of bias of included studies was assessed. Dichotomous outcomes were reported as relative risks (RR), and continuous outcomes were reported as weighted mean differences (WMD) with 95% confidence intervals (CI). The primary outcomes were number of oocytes retrieved, number of mature [metaphase II (MII)] oocytes, clinical pregnancy rate and ongoing pregnancy rate; other IVF outcomes were considered as secondary outcomes.
RESULTS: Seven studies were identified, and 898 patients were eligible for inclusion in this meta-analysis. The results showed that the number of oocytes retrieved [WMD = 1.38 (95% CI 0.47-2.28), I2 = 66%, p = 0.003, low evidence], number of MII oocytes [WMD = 0.7 (95% CI 0.35-1.05), I2 = 42%, p < 0.0001, moderate evidence], number of embryos [WMD = 0.68 (95% CI 0.07-1.3), I2 = 67%, p = 0.03, low evidence] and number of good-quality embryos [WMD = 1.14 (95% CI 0.35-1.93), I2 = 0%, p = 0.005, moderate evidence] in the dual trigger group were significantly higher than in the hCG trigger group. The results of the ovarian response subgroup analysis showed significant differences in all of these outcomes in normal responders, and no differences in any of the outcomes in low responders, except for the number of MII oocytes. In low responders, clinical pregnancy rates may be improved in the dual trigger group [RR = 2.2 (95% CI 1.05-4.61), I2 = 28%, p = 0.04, low evidence].
CONCLUSIONS: Dual triggering by GnRH agonist and hCG improved oocyte maturity and embryo grading for normal responders in GnRH-antagonist cycles. Dual triggering for final oocyte maturation may improve clinical pregnancy rates in low responders.
摘要：
目的：对所有随机对照试验（RCTs）进行系统评价和荟萃分析，这些试验研究了双重触发[促性腺激素释放激素（GnRH）激动剂和人绒毛膜促性腺激素（hCG）的组合]最终卵母细胞成熟是否可以改善低反应者或正常反应者使用体外受精/IVF计划（ICSI）内单精子注射（ICSI）中的联合应用。
方法：截至2022年10月的研究来自PubMed，Scopus,Cochrane图书馆和WebofScience。评估纳入研究的偏倚风险。双分类结果报告为相对风险(RR)，和连续结局报告为加权平均差异(WMD)和95%置信区间(CI).主要结果是检索到的卵母细胞数量，成熟[中期II（MII）]卵母细胞的数量，临床妊娠率和持续妊娠率;其他IVF结局被视为次要结局.
结果：确定了七项研究，898例患者符合纳入本荟萃分析的条件.结果表明，检索到的卵母细胞数[WMD=1.38（95％CI0.47-2.28），I2=66%，p=0.003，低证据]，MII卵母细胞数量[WMD=0.7（95%CI0.35-1.05），I2=42%，p<0.0001，中度证据]，胚胎数量[WMD=0.68（95%CI0.07-1.3），I2=67%，p=0.03，低证据]和优质胚胎数量[WMD=1.14（95％CI0.35-1.93），I2=0%，p=0.005，中度证据]双触发组显著高于hCG触发组。卵巢反应亚组分析结果显示，所有这些结果在正常反应者中存在显著差异，低反应者的任何结果都没有差异，除了MII卵母细胞的数量。在低反应者中，双触发组的临床妊娠率可能会提高[RR=2.2（95％CI1.05-4.61），I2=28%，p=0.04，低证据]。
结论：GnRH激动剂和hCG双重触发可改善GnRH拮抗剂周期中正常反应者的卵母细胞成熟度和胚胎分级。最终卵母细胞成熟的双重触发可能会提高低反应者的临床妊娠率。
方法：截至2022年10月的研究来自PubMed，Scopus,Cochrane图书馆和WebofScience。评估纳入研究的偏倚风险。双分类结果报告为相对风险(RR)，和连续结局报告为加权平均差异(WMD)和95%置信区间(CI).主要结果是检索到的卵母细胞数量，成熟[中期II（MII）]卵母细胞的数量，临床妊娠率和持续妊娠率;其他IVF结局被视为次要结局.
结果：确定了七项研究，898例患者符合纳入本荟萃分析的条件.结果表明，检索到的卵母细胞数[WMD=1.38（95％CI0.47-2.28），I2=66%，p=0.003，低证据]，MII卵母细胞数量[WMD=0.7（95%CI0.35-1.05），I2=42%，p<0.0001，中度证据]，胚胎数量[WMD=0.68（95%CI0.07-1.3），I2=67%，p=0.03，低证据]和优质胚胎数量[WMD=1.14（95％CI0.35-1.93），I2=0%，p=0.005，中度证据]双触发组显著高于hCG触发组。卵巢反应亚组分析结果显示，所有这些结果在正常反应者中存在显著差异，低反应者的任何结果都没有差异，除了MII卵母细胞的数量。在低反应者中，双触发组的临床妊娠率可能会提高[RR=2.2（95％CI1.05-4.61），I2=28%，p=0.04，低证据]。
结论：GnRH激动剂和hCG双重触发可改善GnRH拮抗剂周期中正常反应者的卵母细胞成熟度和胚胎分级。最终卵母细胞成熟的双重触发可能会提高低反应者的临床妊娠率。
