Low dosing of gonadotropins in in vitro fertilization cycles for women with poor ovarian reserve: systematic review and meta-analysis.

Autor:	Youssef MA; Centre for Reproductive Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands; Department of Obstetrics & Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt. Electronic address: mohamedyoussef1973@gmail.com., van Wely M; Centre for Reproductive Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands., Mochtar M; Centre for Reproductive Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands., Fouda UM; Department of Obstetrics & Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt., Eldaly A; Department of Obstetrics & Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt., El Abidin EZ; Department of Obstetrics & Gynecology, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt., Elhalwagy A; Department of Obstetrics & Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt., Mageed Abdallah AA; Department of Obstetrics & Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt., Zaki SS; Department of Obstetrics & Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt., Abdel Ghafar MS; Department of Obstetrics & Gynecology, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt., Mohesen MN; Department of Obstetrics & Gynecology, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt., van der Veen F; Centre for Reproductive Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands.
Jazyk:	angličtina
Zdroj:	Fertility and sterility [Fertil Steril] 2018 Feb; Vol. 109 (2), pp. 289-301. Date of Electronic Publication: 2018 Jan 06.
DOI:	10.1016/j.fertnstert.2017.10.033
Abstrakt:	Objective: To evaluate the effectiveness of low doses of gonadotropins and gonadotropins combined with oral compounds compared with high doses of gonadotropins in ovarian stimulation regimens in terms of ongoing pregnancy per fresh IVF attempt in women with poor ovarian reserve undergoing IVF/intracytoplasmic sperm injection (ICSI) treatment. Design: A systematic review and meta-analysis of randomized controlled studies that evaluate the effectiveness of low dosing of gonadotropins alone or combined with oral compounds compared with high doses of gonadotropins in women with poor ovarian reserve undergoing IVF/ICSI treatment. Setting: Not applicable. Patient(s): Subfertile women with poor ovarian reserve undergoing IVF/ICSI treatment. Intervention(s): We searched the PubMed, EMBASE, Web of Science, the Cochrane Library, and the Clinical Trials Registry using medical subject headings and free text terms up to June 2016, without language or year restrictions. We included randomized controlled studies (RCTs) enrolling subfertile women with poor ovarian reserve undergoing IVF/ICSI treatment and comparing low doses of gonadotropins and gonadotropins combined with oral compounds versus high doses of gonadotropins. We assessed the risk of bias using the criteria recommended by the Cochrane Collaboration. We pooled the results by meta-analysis using the fixed and random effects model. Main Outcomes Measure(s): The primary outcome was ongoing pregnancy rate (PR) per woman randomized. Result(s): We retrieved 787 records. Fourteen RCTs (N = 2,104 women) were included in the analysis. Five studies (N = 717 women) compared low doses of gonadotropins versus high doses of gonadotropins. There was no evidence of a difference in ongoing PR (2 RCTs: risk rate 0.98, 95% confidence interval 0.62-1.57, I 2 = 0). Nine studies (N = 1,387 women) compared ovarian stimulation using gonadotropins combined with the oral compounds letrozole (n = 6) or clomiphene citrate (CC) (n = 3) versus high doses of gonadotropins. There was no evidence of a difference in ongoing PR (3 RCTs: risk rate 0.90, 95% confidence interval 0.63-1.27, I 2 = 0). Conclusion(s): We found no evidence of a difference in pregnancy outcomes between low doses of gonadotropins and gonadotropins combined with oral compounds compared with high doses of gonadotropins in ovarian stimulation regimens. Whether low doses of gonadotropins or gonadotropins combined with oral compounds is to be preferred is unknown, as they have never been compared head to head. A health economic analysis to test the hypothesis that an ovarian stimulation with low dosing is more cost-effective than high doses of gonadotropins is needed. Prospero Registration Number: CRD42016041301. (Copyright © 2017 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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