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Abstract：
The aim of this systematic review and meta-analysis was to quantify the effect of random start ovarian stimulation (RSOS) compared with conventional start ovarian stimulation (CSOS) in cancer patients before gonadotoxic treatment. The final analytical cohort encompassed 688 RSOS and 1076 CSOS cycles of cancer patients before gonadotoxic treatment. Eleven studies were identified by database searches of MEDLINE, Cochrane Library and cited references. The primary outcomes of interest were the number of oocytes and mature oocytes collected, the number of embryos cryopreserved and the metaphase II (MII)-antral follicle count (AFC) ratio. The studies were rated from medium to high quality (from 6 to 9) according to the Newcastle-Ottawa Quality Assessment Scale. The two protocols resulted in similar numbers of oocytes collected, MII oocytes, embryos available for cryopreservation and comparable MII-AFC and fertilization rates. The duration of ovarian stimulation was longer (standardized mean difference [SMD] 0.35, 95% CI 0.09 to 0.61; P = 0.009) and gonadotrophin consumption was higher (SMD 0.23, 95% CI 0.06 to 0.40; P = 0.009) in RSOS compared with CSOS. This systematic review and meta-analysis show that the duration of stimulation is longer, and the total gonadotrophin consumption is higher in cancer patients undergoing RSOS compared with those undergoing CSOS, with no significant effect on mature oocyte yield.
摘要：
这项系统评价和荟萃分析的目的是量化在性腺毒性治疗前的癌症患者中，随机开始卵巢刺激（RSOS）与常规开始卵巢刺激（CSOS）相比的效果。最终的分析队列包括促性腺激素治疗前的688个RSOS和1076个CSOS周期的癌症患者。通过MEDLINE的数据库搜索确定了11项研究，Cochrane图书馆和引用的参考文献。感兴趣的主要结果是收集的卵母细胞和成熟卵母细胞的数量，冷冻保存的胚胎数量和中期II（MII）-窦卵泡计数（AFC）比率。根据纽卡斯尔-渥太华质量评估量表，研究从中质量到高质量（从6到9）。这两个方案导致了相似数量的卵母细胞收集，MII卵母细胞，可用于冷冻保存的胚胎和可比的MII-AFC和受精率。与CSOS相比，RSOS的卵巢刺激持续时间更长（标准化平均差[SMD]0.35，95％CI0.09至0.61；P=0.009），促性腺激素消耗更高（SMD0.23，95％CI0.06至0.40；P=0.009）。这项系统评价和荟萃分析表明，刺激的持续时间更长，与接受CSOS的癌症患者相比，接受RSOS的癌症患者的促性腺激素总消耗量更高，对成熟卵母细胞产量无显著影响。
