Efficacy and safety of progestin-primed ovarian stimulation protocol versus gonadotropin-releasing hormones (GnRH) antagonists in poor responders: a systematic review and meta-analysis
Bibliographic record
Abstract
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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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.016 | 0.032 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.022 | 0.038 |
| Bibliometrics | 0.005 | 0.005 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".