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Meta-Analysis
. 2017 Apr 24;12(4):e0175985.
doi: 10.1371/journal.pone.0175985. eCollection 2017.

Comparisons of GnRH antagonist protocol versus GnRH agonist long protocol in patients with normal ovarian reserve: A systematic review and meta-analysis

Ruolin Wang  1   2 , Shouren Lin  1 , Yong Wang  1 , Weiping Qian  1 , Liang Zhou  1
Affiliations
Meta-Analysis

Comparisons of GnRH antagonist protocol versus GnRH agonist long protocol in patients with normal ovarian reserve: A systematic review and meta-analysis

Ruolin Wang et al. PLoS One. .

Abstract

Objective: To evaluate the effectiveness and safety of gonadotropin-releasing hormone antagonist (GnRH-ant) protocol and gonadotropin-releasing hormone agonist (GnRH-a) long protocol in patients with normal ovarian reserve.

Methods: We searched the PubMed (1992-2016), Cochrane Library (1999-2016), Web of Science (1950-2016), Chinese Biomedical Database (CBM, 1979-2016), and China National Knowledge Infrastructure (CNKI, 1994-2016). Any randomized controlled trials (RCTs) that compared GnRH-ant protocol and GnRH-a long protocol in patients with normal ovarian reserve were included, and data were extracted independently by two reviewers. The meta-analysis was performed by Revman 5.3 software.

Results: Twenty-nine RCTs (6399 patients) were included in this meta-analysis. Stimulation days (mean difference (MD) [95% confidence interval (CI)] = -0.8 [-1.36, -0.23], P = 0.006), gonadotrophin (Gn) dosage (MD [95% CI] = -3.52 [-5.56, -1.48], P = 0.0007), estradiol (E2) level on the day of human chorionic gonadotrophin (HCG) administration (MD [95% CI] = -365.49 [-532.93, -198.05], P<0.0001), the number of oocytes retrieved (MD [95% CI] = -1.41 [-1.84, -0.99], P<0.00001), the embryos obtained (MD [95% CI] = -0.99 [-1.38, -0.59], P<0.00001), incidence of ovarian hyperstimulation syndrome (OHSS) (OR [95% CI] = 0.69 [0.57, 0.83], P<0.0001) were statistically significantly lower in GnRH-ant protocol than GnRH-a long protocol. However, the clinical pregnancy rate (OR [95% CI] = 0.90 [0.80, 1.01], P = 0.08), ongoing pregnancy rate (OR [95% CI] = 0.88 [0.77, 1.00], P = 0.05), live birth rate (OR [95% CI] = 0.95 [0.74, 1.09], P = 0.27), miscarriage rate (OR [95% CI] = 0.98 [0.69, 1.40], P = 0.93), and cycle cancellation rate (OR [95% CI] = 0.86 [0.52, 1.44], P = 0.57) showed no significant differences between the two groups.

Conclusion: GnRH-ant protocol substantially decreased the incidence of OHSS without influencing the pregnancy rate and live birth rate compared to GnRH-a long protocol among patients with normal ovarian reserve.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Literature screening flow diagram.
From: Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group (2009). Preferred Reporting Items for Systemetic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med 6(7): e1000097. doi:10.1371/journal.pmed1000097. For more information, visit www.prisma-statement.org.
Fig 2
Fig 2. Forest plot comparing the clinical pregnancy rate per woman randomized between the GnRH-ant group and the GnRH-a long-protocol group.
Fig 3
Fig 3. Forest plot comparing the ongoing pregnancy rate per woman randomized between the GnRH-ant group and the GnRH-a long-protocol group.
Fig 4
Fig 4. Forest plot comparing the live birth rate per woman randomized between the GnRH-ant group and the GnRH-a long-protocol group.
Fig 5
Fig 5. Forest plot comparing the number of stimulation days per woman randomized between the GnRH-ant group and the GnRH-a long-protocol group.
Fig 6
Fig 6. Forest plot comparing the Gn dosage per woman randomized between the GnRH-ant group and the GnRH-a long-protocol group.
Fig 7
Fig 7. Forest plot comparing the endometrial thickness on the day of HCG administration per woman randomized between the GnRH-ant group and the GnRH-a long-protocol group.
Fig 8
Fig 8. Forest plot comparing the E2 level on the day of HCG administration per woman randomized between the GnRH-ant group and the GnRH-a long-protocol group.
Fig 9
Fig 9. Forest plot comparing the number of oocytes retrieved per woman randomized between the GnRH-ant group and the GnRH-a long-protocol group.
Fig 10
Fig 10. Forest plot comparing the number of embryos obtained per woman randomized between the GnRH-ant group and the GnRH-a long-protocol group.
Fig 11
Fig 11. Forest plot comparing the incidence of OHSS per woman randomized between the GnRH-ant group and the GnRH-a long-protocol group.
Fig 12
Fig 12. Forest plot comparing the miscarriage rate per woman randomized between the GnRH-ant group and the GnRH-a long-protocol group.
Fig 13
Fig 13. Forest plot comparing the cycle cancellation rate per woman randomized between the GnRH-ant group and the GnRH-a long-protocol group.
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