PDF(Pubmed)
Abstract：
In vitro fertilization (IVF) and embryo transfer and intracytoplasmic sperm injection (ICSI) have allowed millions of infertile couples to achieve pregnancy. As an essential part of IVF/ICSI enabling the retrieval of a high number of oocytes in one cycle, controlled ovarian stimulation (COS) treatment mainly composes of the standard long gonadotrophin-releasing hormone agonist (GnRH-a) protocol and the gonadotrophin-releasing hormone antagonist (GnRH-ant) protocol. However, the effectiveness of GnRH-ant protocol is still debated because of inconsistent conclusions and insufficient subgroup analyses. This systematic review and meta-analysis included a total of 52 studies, encompassing 5193 participants in the GnRH-ant group and 4757 in the GnRH-a group. The findings of this study revealed that the GnRH-ant protocol is comparable with the long GnRH-a protocol when considering live birth as the primary outcome, and it is a favourable protocol with evidence reducing the incidence of ovarian hyperstimulation syndrome in women undergoing IVF/ICSI, especially in women with polycystic ovary syndrome. Further research is needed to compare the subsequent cumulative live birth rate between the two protocols among the general and poor ovarian response patients since those patients have a lower clinical pregnancy rate, fewer oocytes retrieved or fewer high-grade embryos in the GnRH-ant protocol.
摘要：
体外受精（IVF）和胚胎移植和卵胞浆内单精子注射（ICSI）使数百万不育夫妇实现了怀孕。作为IVF/ICSI的重要组成部分，能够在一个周期中检索大量卵母细胞，控制性卵巢刺激（COS）治疗主要包括标准的促性腺激素释放激素激动剂（GnRH-a）方案和促性腺激素释放激素拮抗剂（GnRH-ant）方案。然而,由于结论不一致和亚组分析不足,GnRH-ant方案的有效性仍存在争议.这项系统评价和荟萃分析共包括52项研究，GnRH-ant组5193名参与者和GnRH-a组4757名参与者.这项研究的结果表明，当考虑活产作为主要结果时，GnRH-ant方案与长GnRH-a方案相当。这是一项有利的方案，有证据表明可以降低接受IVF/ICSI的女性卵巢过度刺激综合征的发生率，尤其是多囊卵巢综合征的女性。需要进一步的研究来比较一般和卵巢反应不良患者中两种方案之间的后续累积活产率，因为这些患者的临床妊娠率较低。GnRH-ant方案中回收的卵母细胞较少或高级胚胎较少。
