拮抗剂方案和长方案促排卵对PCOS患者妊娠结局影响的Meta分析

目的探讨拮抗剂方案对PCOS患者IVF-ET妊娠结局的影响。方法利用计算机检索PubMed、Embase、Cochrane Library、Web of Science、中国知网、维普网和万方数据库,检索时间自建库至2019年9月,检索关于PCOS患者在辅助生殖过程中,使用拮抗剂方案和常规长方案促排卵相关的RCT,参照本研究制定的纳入和排除标准进行文献筛选,对纳入的研究进行数据提取和质量评价后,利用Stata15.1软件进行Meta分析。结果经过文献筛选,本研究共纳入12篇RCT文献,共纳入1 545名受试者,其中拮抗剂方案组781人,常规长方案组764人。Meta分析结果示:(1)拮抗剂方案可以显著降低PCOS患者卵巢过度刺激综合征(OHSS)发生率OR=0.35,95%CI(0.25,0.50),P<0.01],但两组之间的临床妊娠率没有显著性差异OR=1.06,95%CI(0.84,1.34),P=0.606];(2)拮抗剂方案可以显著降低PCOS患者的Gn天数、Gn总剂量和HCG日E2水平Gn天数:SMD=-0.47,95%CI(-0.70,-0.24),P<0.001;Gn总剂量:SMD=-0.55,95%CI(-0.94,-0.17),P=0.004;HCG日E2水平:SMD=-0.18,95%CI(-0.35,0.01),P=0.004];(3)拮抗剂方案组患者的获卵数、周期取消率、持续妊娠率、多胎妊娠率和流产率均与常规长方案组无显著性差异(P>0.05)。结论相比于长方案,PCOS患者应用拮抗剂方案可以获得相似的临床妊娠率,但显著降低其OHSS发生率、Gn天数、Gn总剂量和HCG日E2水平;但该结论仍需更多的大样本量、多中心的RCT研究加以佐证。

A meta-analysis of effect of GnRH antagonist protocol on pregnancy outcome in PCOS patients with assisted reproductive technology

Objective:To investigate the effect of antagonist protocol on pregnancy outcomes in patients with polycystic ovary syndrome(PCOS)undergone IVF-ET treatment.Methods:PubMed,Embase,Cochrane Library,Web of Science,WANFANG,CNKI and VIP databases were electronically searched to collect randomized controlled trials(RCTs)regarding the comparison between standard GnRH agonist long protocol and antagonist protocol for PCOS patients with IVF-ET treatment from building library to September 2019.Two reviewers independently screened literature,extracted data,and assessed the risk of bias of included RCTs.Then,a meta-analysis was performed by Stata 15.1 software.Results:A total of 12 RCT literatures with 1545 subjects were included in this study,781 in the GnRH antagonist protocol group and 764 in the standard GnRH agonist long protocol group.Meta analysis results showed that antagonist protocol significantly reduced the incidence of ovarian hyperstimulation syndrome(OHSS)in patients with PCOSOR=0.35,95%CI(0.25,0.50),P<0.01],but there was no significant difference in the clinical pregnancy rates between the two groupsOR=1.06,95%CI(0.84,1.34),P=0.606].Antagonist protocol significantly reduced the total daysSMD=-0.47,95%CI(-0.70,-0.24),P<0.001]and doseSMD=-0.55,95%CI(-0.94,-0.17),P=0.004]of gonadotropin used and the estradiol level on HCG daySMD=-0.18,95%CI(-0.35,0.01),P=0.004]in PCOS patients.The number of oocytes retrieved,cycle cancellation rates,ongoing pregnancy rates,multiple pregnancy rates and miscarriage rates of patients in the antagonist protocol group were not significantly different from those in the standard GnRH agonist long protocol group(P>0.05).Conclusions:Antagonist protocol can obtain similar clinical pregnancy rate,but significantly reduces the incidence of OHSS,total days and doses of gonadotropin used,and the estradiol level on HCG day in PCOS patients.Due to limited quality and quantity of the included studies,larger sample size and multicenter RCTs are needed to verify the above conclusions.