Efficacy and safety of progestin-primed ovarian stimulation protocol versus gonadotropin-releasing hormones (GnRH) antagonists in poor responders: a systematic review and meta-analysis
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Résumé
Introduction: This systematic review and meta-analysis aimed to update the existing evidence regarding the efficacy and safety of the progestin-primed ovarian stimulation (PPOS) compared to ovarian stimulation (OS) with GnRH antagonists in patients with poor ovarian response (POR). Material and methods: A comprehensive literature search was conducted in PubMed/Medline, Google Scholar, CENTRAL, Scopus, and ClinicalTrials.gov up to March 2024 to identify studies comparing the use of PPOS to GnRH antagonists in patients with poor ovarian response. All relevant studies were included in the systematic review, regardless of the specific definition of poor ovarian reserve, the type and dose of progestin used, the type of gonadotropins administered, and the regimen for final maturation. Only studies in English were included. The primary outcome was the number of cumulus oocyte complexes (COCs) retrieved. Secondary outcomes included the incidence of premature LH surge, cycle cancellation rate, total dose and duration of gonadotropins required for ovarian stimulation, number of mature (MII) oocytes, number of 2 pro-nuclei (2PN) fertilized oocytes, clinical pregnancy rate, live birth rate (LBR), cumulative live birth rate (CLBR) and abortion rate. The quality of the studies included was assessed by the use of Risk of Bias (Rob2) tool for RCTs and Newcastle-Ottawa Quality Assessment Scale for the observational studies. Dichotomous data were expressed as risk differences (RD) or odds ratios (OR) with 95% confidence intervals (CI), while continuous outcomes were presented as weighted mean differences (WMD) with 95% CI. Meta-analysis was performed using IBM SPSS v.28. Publication bias was assessed with Egger’s test. Heterogeneity among studies was evaluated using the I². A fixed effects model was used if no significant heterogeneity was found (I2<50%), and a random effects model was applied if significant heterogeneity was present (I2≥50%). The level of statistical significance was set at 0.05. Results: The present systematic review and meta-analysis evaluated 1 RCT and 8 retrospective studies, including 3488 patients in total. The results of this meta-analysis revealed no significant difference in the number of COCs received (WMD: 0.15, 95% CI: 0.52 to 0.22), clinical pregnancy rate (OR: 1.38, 95% CI: 0.94 to 2.03), CLBR (RD: -4%, 95% CI: -0.10 to 0.02), LBR (RD: 8%, 95% CI: -0.04 to 0.19), the number of 2PN fertilized oocytes (WMD: 0.20, 95% CI: -0.02 to 0.43), mature oocyte rate (RD: 10%, 95% CI: -0.10 to 0.31), the number of mature oocytes (WMD: 0.35, 95% CI: -0.12 to 0.82), cycle cancellation rate (RD: -7 %, 95% CI: -0.25 to 0.12), miscarriage rate (RD: 0%, 95% CI: -0.13 to 0.12), the total dose of gonadotropins (WMD: 67.70 IUs, 95% CI: -33.87 to 169.27), the duration of ovarian stimulation (WMD: -0.11 days, 95% CI: -0.34 to 0.12) and the incidence of premature LH surge (RD: 0%, 95% CI: -0.12 to 0.13) between the PPOS protocol and the GnRH antagonists. Conclusion: PPOS is an ovarian stimulation protocol with similar results compared to GnRH antagonists and may be used for patients with poor ovarian response.
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Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découle