| Objective:To evaluate the effectiveness and safety of three controlled ovarian hyperstimulation protocols including GnRH antagonist protocol,GnRH agonist long protocol and mind stimulation protocol in vitro fertilization-embyro transfer(IVF-ET)for polycystic ovary syndrome(PCOS)patients.Methods:We searched PubMed(1997 ~ 2016.11),EMbase(searched from inception to Noverber 2016),The Cochrane library(searched from inception to Noverber 2016),CBM(1979 ~ 2016.11),VIP(1989 ~ 2016.11),WangFang Data(1994 ~ 2016.11),CNKI(1994 ~ 2016.11)by computer systematically and comprehensively.As a supplement,we handsearched five reproductive medicine journals and the references cited in the literature.Two review authors independently screened the relevant citations for randomized controlled trials(RCTs)on the effectiveness of GnRH agonist long protocol,GnRH antagonist protocol versus mind stimulation protocol in IVF-ET for PCOS patients.These RCTs were screened according to the inclusive and excluded criteria by two reviewers and data was extracted independently.The RevMan 5 was used for quality evaluation.The StataSE 12.0 software was used for Meta-analyses.Result:We included Twenty-three RCTs,with 2629 participants.The results of meta-analysis showed that there were significant differences between GnRH antagonist protocol group and GnRH agonist long protocol group in the stimulation duration[SMD=-0.69(-0.9,-0.48)],dose of gonadotrophins[SMD=-0.56(-0.82,-0.30)],serum E2 value on the day of HCG administration[SMD=-0.48(-0.75,-0.21)],OHSS rate[OR=0.43(0.297,0.624)],number of oocytes retrieved[SMD=-0.11(-0.20,-0.02)].Compared with the GnRH agonist group,there was no significant difference in the GnRH antagonist group about the serum progesterone value on the day of HCG administration[SMD=0.02(-0.16,0.21)],serum LH value on the day of HCG administration[SMD=0.63(-0.16,1.42)],endometrial thickness on the day of HCG administration[SMD=-0.30(-0.62,0.03)],implantation rate[OR=0.97(0.78,1.19)],clinical pregnancy rate[OR=1.03(0.87,1.22)],ongoing pregnancy rate[OR=0.99(0.75,1.30)],abortion rate[OR=0.95(0.58,1.58)],multiple birth rate[OR=0.98(0.67,1.43)],cycle cancellation rate[OR=0.78(0.57,1.08)].There were significant differences between mind stimulation protocol group and GnRH agonist long protocol group in the stimulation duration[SMD=-1.97(-3.39,-0.56)],dose of gonadotrophins[SMD=-2.10(-2.62,-1.57)]、serum E2 value on the day of HCG administration[SMD=-3.12(-4.24,-2.00)],number of oocytes retrieved[SMD=-1.18(-1.74,0.62)],OHSS rate[OR=0.32(0.18,0.57)],cycle cancellation rate[OR=0.59(0.37,0.94)],serum LH value on the day of HCG administration[SMD=1.99(1.21,2.76)]、serum progesterone value on the day of HCG administration[SMD=0.54(0.28,0.81)].Compared with the GnRH long agonist group,there was no significant difference in the mind stimulation group about the endometrial thickness on the day of HCG administration[SMD=-1.27(-2.59,0.05)],implantation rate[SMD=0.92(0.63,1.35)],clinical pregnancy rate[SMD=1.13(0.78,1.64)],abortion rate[OR=0.91(0.19,4.33)].Conclusions:Compared with the GnRH agonist long protocol,the GnRH antagonist protocol can obviously decrease the stimulation days,dose of gonadotrophins,serum E2 value on the day of HCG administration and the incidence of OHSS,but has the same effect in the implantation rate,clinical pregnancy rate and abortion rate.GnRH antagonist protocol can reduce the duration of treatment,the amount of gonadotrophins and the OHSS rate which is much safer and better.It could be used as an good alternative to GnRH agonist long protocol for PCOS patients.The mind stimulation protocol is a new type of treatment.On the premise of the same clinical pregnancy rate,the use of mind stimulation protocol is associated with a reduction in treatment duration,the total amount of gonadotrophins,OHSS rate and frozen-thawed transfer rate.Although mind stimulation protocol will decrease the number of oocytes retrieved,it has advantage of low cost and much safer.So mind stimulation protocol could be an ideal choice for PCOS patients.On account of the quality and quantity limitation of the included RCTs,the conclusion form this study has some limitations which should be revalued and updated unceasingly. |
PDF Full Text Request