摘要
目的比较高孕激素状态下促排卵方案(PPOS)与拮抗剂方案应用于卵巢低反应(POR)患者的促排卵疗效及安全性分析。方法计算机检索PubMed、Embase、Cochrane library、中国知网(CNKI)、万方数据知识服务平台、维普数据库等至2019年9月所有PPOS方案与GnRH拮抗剂方案应用于POR患者的随机对照试验和临床对照试验,按照纳入和排除标准对文献进行筛选,对于符合条件的数据进行Meta分析。结果本研究共纳入7篇文献1309例患者,其中691例使用PPOS方案,618例使用GnRH拮抗剂方案。Meta分析结果显示:PPOS方案与GnRH拮抗剂方案相比,其促性腺激素(Gn)使用时间增加[MD=0.42,95%CI(0.11,0.74)],Gn用量减少[MD=-287.82,95%CI(-380.96,194.67)]及早发LH峰发生率降低[OR=0.38,95%CI(0.19,0.77)],而获卵数也减少[MD=-0.25,95%CI(-0.44,-0.05)],但两种方案的受精率[OR=1.14,95%CI:(0.97,1.36)]、优胚率[OR=1.13,95%CI(0.94,1.36)]、周期取消率[OR=1.17,95%CI(0.85,1.61)]及临床妊娠率[OR=1.46,95%CI(0.92,2.32)]均无统计学差异。结论PPOS方案的临床结局与GnRH拮抗剂方案对促排卵的疗效无显著性差异,但是PPOS方案能获得与拮抗剂方案相当的优胚率,同时能更好地降低早发LH峰发生率,在POR患者中的应用具有一定的积极意义。
Objective:To compare the clinical efficacy of ovulation and security between progestin-primed ovarian stimulation(PPOS)protocol and GnRH antagonist protocol for patients with poor ovarian response(POR).Methods:The databases including PubMed,Embase,Cochrane library,CNKI,VIP and Wanfang Databases were electronically searched for the clinical trials on comparison of clinical efficacy between PPOS protocol and GnRH antagonist protocol in the POR patients until September 2019.The extracted data from trials were filtered according to the inclusion and exclusion standard for meta-analysis with RevMan 5.3.Results:Seven papers including 1309 cycles were included in the meta-analysis.There were 691 cycles with PPOS protocol and 618 cycles with GnRH antagonist protocol.The meta-analysis showed that the duration of gonadotropin was longer[MD=0.42,95%CI(0.11,0.74)],total doses of gonadotropin was less[MD=-287.82,95%CI(-380.96,194.67)],premature LH surge rate was lower[OR=0.38,95%CI(0.19,0.77)]and number of retrieved oocytes was less[MD=-0.25,95%CI(-0.44,-0.05)]in PPOS protocol compared with GnRH antagonist protocol.However,there were no statistical differences in fertilization rate[OR=1.14,95%CI(0.97,1.36)],good-quality embryo rate[OR=1.13,95%CI(0.94,1.36)],cycle cancellation rate[OR=1.17,95%CI(0.85,1.61)]and clinical pregnancy rate[OR=1.46,95%CI(0.92,2.32)].Conclusions:There is no significant difference in clinical efficacy between the PPOS protocol and GnRH antagonist protocol in POR patients.However,the PPOS protocol can obtain similar good-quality embryo rate as the antagonist protocol,and can further reduce the incidence of early-onset LH peak.The application in POR patients has certain positive significance.
作者
陈雅婕
吴庚香
CHEN Ya-jie;WU Geng-xiang(Reproductive Medical Centre,Renmin Hospital of Wuhan University,Wuhan 430060)
出处
《生殖医学杂志》
CAS
2020年第7期925-931,共7页
Journal of Reproductive Medicine
基金
国家自然科学基金项目(NO.81873817)。
