Effects of oral contraceptive for different responder women before GnRH antagonists: a systematic review and meta-analysis

Abstract

This analysis aimed to compare the efficacy of oral contraceptive pill (OCP) pretreatment for gonadotropin-releasing hormone antagonist (GnRH-ant) protocol, especially for different responder women. The PubMed, EMBASE, and Chinese National Knowledge Infrastructure (CNKI) databases were searched for trials on with and without OCP pretreatment before stimulation with gonadotropins. The standardized mean differences (SMDs) or pooled risk ratios (RRs) with 95% confidence intervals (CIs) were used for statistical analysis. Fifteen studies with 5326 in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) cycles were summarized. The clinical pregnancy rate, moderate or severe ovarian hyper-stimulation syndrome (OHSS) rate, and miscarriage rate was not found to be significantly different between patients with and those without OCP pretreatment, even after sensitivity analyses. In addition, there were still no statistically significant differences for the subgroups analyses of hyper-responders, poor responders, and normal responders. No significant differences were detected in the duration of ovarian stimulation, gonadotropin dose consumed, endometrial thickness on day of oocyte collection, or number of oocytes. This meta-analysis did not find an unequivocally beneficial effect of OCP pretreatment for different responder women with using a GnRH-ant protocol. The clinician should weigh the advantages and disadvantages of OCP pretreatment and guide the treatment scheduling considering the patient’s own situation.

GnRH拮抗剂前口服避孕药对不同反应女性的影响：系统评价和meta分析 摘要

该分析旨在比较口服避孕药（OCP）预处理对促性腺激素释放激素拮抗剂（GnRH-ant）方案的疗效, 尤其是对不同反应的女性。在PubMed、EMBASE和中国国家知识基础设施（CNKI）数据库中搜索了促性腺激素刺激前采用和不采用OCP预处理的试验。采用标准化均数差（SMDs）或95%可信区间（CIs）的合并危险比（RRs）进行统计分析。总结了15项研究, 5326个体外受精（IVF）/卵胞浆内单精子注射（ICSI）周期。即使经过敏感性分析, 临床妊娠率、中、重度卵巢过度刺激综合征（OHSS）发生率、流产率在OCP预处理组与未用OCP预处理组之间无显著差异。此外, 在对高反应者、低反应者和正常反应者的分组分析中, 仍然没有统计学上的显著差异。两组在卵巢刺激持续时间、促性腺激素用量、取卵日的子宫内膜厚度、卵母细胞数方面均无显著差异。这项meta分析没有发现OCP预处理对采用GnRH-ant方案的不同反应女性有明确的益处。临床医生应权衡OCP预处理的利弊, 结合患者自身情况指导治疗计划。

Keywords:

• OCP
• pretreatment
• GnRH antagonist
• ART

Disclosure statement

No potential conflict of interest was reported by the author(s).

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Additional information

Funding

This study was supported by grants from Guangxi Medical and Health Appropriate Technology Development and Promotion and Application Project in 2020 [S2020090], the research project of Family Planning Research Center of Guangxi Zhuang Autonomous Region [2019GXZJK03].