■在IVF或ICSI治疗中,确定孕激素引发的卵巢刺激(PPOS)对卵巢储备(DOR)减少的女性是否比柠檬酸氯米芬(CC)/来曲唑(LE)联合促性腺激素更有效。
■搜索了9个数据库,直到2023年5月24日,以确定相关研究。森林地块被用来呈现这个荟萃分析的结果。Begg\和Egger\的测试被用来估计出版偏差。进行亚组和敏感性分析以检查异质性的潜在来源,并验证合并结果的稳健性。分别。
■共有14项研究纳入4182名参与者进行荟萃分析。有证据表明临床妊娠率显着增加(OR=1.39,95CI[1.01,1.91],p=0.05),最佳胚胎率(OR=1.50,95CI[1.20,1.88],p=0.0004),和累积妊娠率(OR=1.73,95CI[1.14,2.60],p=0.009),所需促性腺激素的持续时间和数量(MD=1.56,95CI[0.47,2.66],p=0.005;SMD=1.51,95CI[0.90,2.12],p<0.00001),随着周期取消率的降低(OR=0.78,95CI[0.64,0.95],p=0.02),hCG当天黄体生成素(LH)水平(SMD=-0.81,95CI[-1.10,-0.53],p<0.00001),和过早的LH喘振率(OR=0.10,95CI[0.07,0.15],p<0.00001)当使用PPOS时。结果中没有发现发表偏倚的证据。
■基于基于证据的结果,PPOS方案似乎可以改善DOR女性的IVF/ICSI结局。需要更多的研究与更大的样本量和严格的设计,以进一步探索PPOS在诊断为DOR的女性中的价值。
■www.crd.约克。AC.英国,标识符CRD42023430202。
To determine whether progestin-primed ovarian stimulation (PPOS) is more effective for women with diminished ovarian reserve (DOR) than
clomiphene citrate (CC)/letrozole (LE) plus gonadotropin in IVF or ICSI treatment.
Nine databases were searched until May 24, 2023, to identify relevant studies. Forest plots were used to present the results of this meta-analysis. Begg\'s and Egger\'s tests were applied to estimate publication bias. Subgroup and sensitivity analysis were performed to check the potential sources of heterogeneity and verify the robustness of the pooled results, respectively.
A total of 14 studies with 4182 participants were included for meta-analysis. There was evidence of a statistically notable increase in clinical pregnancy rate (OR = 1.39, 95%CI [1.01, 1.91], p = 0.05), optimal embryos rate (OR = 1.50, 95%CI [1.20, 1.88], p = 0.0004), and cumulative pregnancy rate (OR = 1.73, 95%CI [1.14, 2.60], p = 0.009), the duration and the amount of gonadotropin required (MD = 1.56, 95%CI [0.47, 2.66], p = 0.005; SMD = 1.51, 95%CI [0.90, 2.12], p < 0.00001), along with decrease cycle cancellation rate (OR = 0.78, 95%CI [0.64, 0.95], p = 0.02), luteinizing hormone (LH) level on the day of hCG (SMD = -0.81, 95%CI [-1.10, -0.53], p < 0.00001), and premature LH surge rate (OR = 0.10, 95%CI [0.07, 0.15], p < 0.00001) when PPOS was used. No evidence for publication bias within results was revealed.
Based on evidence-based results, PPOS protocol seems to improve IVF/ICSI outcomes for women with DOR. More research with larger sample sizes and rigorous designs are required to further explore the value of PPOS among women diagnosed with DOR.
www.crd.york.ac.uk, identifier CRD42023430202.