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首页> 外文期刊>Human reproduction update >GnRH agonist for triggering final oocyte maturation in the GnRH antagonist ovarian hyperstimulation protocol: a systematic review and meta-analysis.
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GnRH agonist for triggering final oocyte maturation in the GnRH antagonist ovarian hyperstimulation protocol: a systematic review and meta-analysis.

机译：在GnRH拮抗剂卵巢过度刺激方案中触发最终卵母细胞成熟的GnRH激动剂：系统评价和荟萃分析。

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Triggering final oocyte maturation with GnRH agonist during ovarian stimulation is feasible when inhibition of premature LH surge is performed with GnRH antagonists, and we aimed to systematically collate evidence on the clinical efficacy of GnRH agonist triggering in patients undergoing assisted reproduction in GnRH antagonist protocols. Twenty-three publications were identified by a comprehensive literature search that included PubMed, Embase and the Cochrane Library. Three publications out of 23 fulfilled the inclusion criteria for meta-analysis, which were (i) prospective, randomized controlled study design; (ii) stimulation with gonadotropins for induction of multifollicular development; (iii) suppression of endogenous LH by a GnRH antagonist; (iv) triggering of final oocyte maturation with GnRH agonist; (v) control group randomized to receive HCG for final oocyte maturation and (vi) any means of luteal phase support other than HCG. The participants were normoovulatory women undergoing IVF. The outcomes assessed were clinical pregnancy per randomized patient; number of oocytes retrieved; proportion of metaphase II oocytes; fertilization rate; embryo quality score; first trimester abortion rate; ovarian hyperstimulation syndrome (OHSS) incidence. Results are presented as combined standardized differences of the mean and combined odds ratios, as appropriate, with 95% confidence intervals. No significant difference was found for the number of oocytes retrieved (-0.94, -0.33-0.14), proportion of metaphase II oocytes (-0.03, -0.58-0.52), fertilization rate (0.15, -0.09-0.38) or embryo quality score (0.05, -0.18-0.29). No OHSS occurred in two of the studies, whereas in one study OHSS incidence was not reported. Thus from the available data, no conclusion can be drawn as regards OHSS incidence after GnRH agonist triggering. In comparison to HCG, GnRH agonist administration is associated with a significantly reduced likelihood of achieving a clinical pregnancy (0.21, 0.05-0.84; P = 0.03). The odds of first trimester pregnancy loss is increased after GnRH agonist triggering; however, the confidence interval crosses unity (11.51, 0.95-138.98; P = 0.05). In conclusion, the use of GnRH agonist to trigger final oocyte maturation in IVF, where inhibition of premature LH surge is achieved with GnRH antagonists, yields a number of oocytes capable to undergo fertilization and subsequent embryonic cleavage, which is comparable to that achieved with HCG. However, the likelihood of an ongoing clinical pregnancy after GnRH agonist triggering is significantly lower as compared to standard HCG treatment.
机译：当使用GnRH拮抗剂抑制过早的LH激增时，在卵巢刺激过程中用GnRH激动剂触发最终卵母细胞成熟是可行的，并且我们旨在系统地整理GnRH激动剂触发在GnRH拮抗剂方案中辅助繁殖的患者的临床疗效证据。通过全面的文献检索确定了23种出版物，其中包括PubMed，Embase和Cochrane图书馆。 23个出版物中有3个满足了荟萃分析的纳入标准，即（i）前瞻性，随机对照研究设计; （ii）用促性腺激素刺激多卵泡发育; （iii）GnRH拮抗剂抑制内源性LH; （iv）用GnRH激动剂触发卵母细胞的最终成熟; （v）对照组随机接受HCG最终卵母细胞成熟;（vi）除HCG以外的任何黄体期支持手段。参与者是接受试管婴儿的正常排卵妇女。评估的结果是每位随机患者的临床妊娠;取回的卵母细胞数; II期卵母细胞比例受精率胚胎质量评分;早孕流产率;卵巢过度刺激综合征（OHSS）发生率。结果显示为均值和组合比值比的组合标准差（视情况而定），置信区间为95％。检索到的卵母细胞数（-0.94，-0.33-0.14），中期II卵母细胞的比例（-0.03，-0.58-0.52），受精率（0.15，-0.09-0.38）或胚胎质量得分没有显着差异（0.05，-0.18-0.29）。在两项研究中未发生OHSS，而在一项研究中未报告OHSS发生率。因此，根据现有数据，无法得出关于GnRH激动剂触发后OHSS发生率的结论。与HCG相比，GnRH激动剂的给药显着降低了获得临床妊娠的可能性（0.21，0.05-0.84; P = 0.03）。促性腺激素释放激素受体激动剂触发后，早孕流产的几率增加;但是，置信区间超过了单位（11.51，0.95-138.98; P = 0.05）。总之，使用GnRH激动剂触发IVF的最终卵母细胞成熟（使用GnRH拮抗剂抑制过早的LH激增可以使卵母细胞能够受精并随后进行卵裂），这与HCG相当。 。但是，与标准HCG治疗相比，GnRH激动剂触发后继续进行临床妊娠的可能性大大降低。

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