Low dosing of gonadotropins in in vitro fertilization cycles for women with poor ovarian reserve: systematic review and meta-analysis
| Autor: | Ashraf Eldaly, Fulco van der Veen, Eman Zein El Abidin, Mohamed Abdelfattah Mahmoud Youssef, Mohamed N Mohesen, Monique H. Mochtar, Mohamed Abd-El Ghafar, Sherif Sameh Zaki, Ahmed Elhalwagy, Ahmed Abdel Mageed Abdallah, Madelon van Wely, Usama M. Fouda |
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| Rok vydání: | 2017 |
| Předmět: |
0301 basic medicine
endocrine system medicine.medical_specialty Pregnancy Rate medicine.medical_treatment Fertilization in Vitro Intracytoplasmic sperm injection 03 medical and health sciences 0302 clinical medicine Ovulation Induction Pregnancy Risk Factors medicine Odds Ratio Humans Ovarian reserve Ovarian Reserve 030219 obstetrics & reproductive medicine In vitro fertilisation Chi-Square Distribution business.industry Obstetrics Letrozole Ovary Obstetrics and Gynecology Fertility Agents Female medicine.disease Pregnancy rate 030104 developmental biology Treatment Outcome Reproductive Medicine Meta-analysis Ovulation induction Drug Therapy Combination Female business Poor ovarian reserve Infertility Female hormones hormone substitutes and hormone antagonists Gonadotropins medicine.drug |
| Zdroj: | Fertility and sterility. 109(2) |
| ISSN: | 1556-5653 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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