促性腺激素释放激素拮抗剂与黄体期促性腺激素释放激素激动剂在体外受精/卵胞浆内单精子显微注射方案中的活产率对比:系统综述和荟萃分析。

IF 4.5 2区 医学 Q1 BIOCHEMISTRY & MOLECULAR BIOLOGY Expert Reviews in Molecular Medicine Pub Date : 2023-12-14 DOI:10.1017/erm.2023.25
Chenhong Liu, Tian Tian, Yanru Lou, Jia Li, Ping Liu, Rong Li, Jie Qiao, Yuanyuan Wang, Rui Yang
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引用次数: 0

摘要

体外受精(IVF)、胚胎移植和卵胞浆内单精子显微注射(ICSI)使数百万不孕夫妇成功怀孕。作为体外受精/卵胞浆内单精子显微注射(IVF/ICSI)的重要组成部分,控制性卵巢刺激(COS)治疗可在一个周期内获取大量卵母细胞,主要包括标准的长效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。这项系统性回顾和荟萃分析共纳入了 52 项研究,其中 GnRH-ant 组有 5193 名参与者,GnRH-a 组有 4757 名参与者。研究结果表明,以活产为主要结果时,GnRH-ant方案与长GnRH-a方案具有可比性,而且有证据表明,GnRH-ant方案可降低接受体外受精/卵胞浆内单精子显微注射(IVF/ICSI)的妇女,尤其是患有多囊卵巢综合征的妇女的卵巢过度刺激综合征发病率。由于 GnRH-ant 方案中一般患者和卵巢反应差的患者的临床妊娠率较低,取到的卵母细胞较少或高等级胚胎较少,因此需要进一步研究比较这两种方案在一般患者和卵巢反应差的患者中的后续累积活产率。
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Live birth rate of gonadotropin-releasing hormone antagonist versus luteal phase gonadotropin-releasing hormone agonist protocol in IVF/ICSI: a systematic review and meta-analysis.

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.

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来源期刊
Expert Reviews in Molecular Medicine
Expert Reviews in Molecular Medicine BIOCHEMISTRY & MOLECULAR BIOLOGY-MEDICINE, RESEARCH & EXPERIMENTAL
CiteScore
7.40
自引率
1.60%
发文量
45
期刊介绍: Expert Reviews in Molecular Medicine is an innovative online journal featuring authoritative and timely Reviews covering gene therapy, immunotherapeutics, drug design, vaccines, genetic testing, pathogenesis, microbiology, genomics, molecular epidemiology and diagnostic techniques. We especially welcome reviews on translational aspects of molecular medicine, particularly those related to the application of new understanding of the molecular basis of disease to experimental medicine and clinical practice.
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