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Meta-Analysis
. 2020 Dec;37(12):2913-2928.
doi: 10.1007/s10815-020-01966-5. Epub 2020 Nov 21.

How effective are the non-conventional ovarian stimulation protocols in ART? A systematic review and meta-analysis

Demian Glujovsky  1   2 , Romina Pesce  3 , Mariana Miguens  4 , Carlos E Sueldo  4   5 , Karinna Lattes  6 , Agustín Ciapponi  7
Affiliations
Meta-Analysis

How effective are the non-conventional ovarian stimulation protocols in ART? A systematic review and meta-analysis

Demian Glujovsky et al. J Assist Reprod Genet. 2020 Dec.

Abstract

Purpose: To compare the effectiveness of starting the ovarian stimulation on the early follicular phase ("Conventional") with the newer range of non-conventional approaches starting in the luteal phase ("Luteal"), random-start, and studies implementing them in DuoStim ("Conventional"+"Luteal").

Methods: Systematic review. We searched CENTRAL, PubMed, and Embase, on March 2020. We included randomized and non-randomized controlled trials that compared "Luteal," random-start ovarian stimulation or DuoStim with "Conventional"; we analyzed them by subgroups: oocyte freezing and patients undergoing ART treatments, both, in the general infertile population and among poor responders.

Results: The following results come from a sensitivity analysis that included only the low/moderate risk of bias studies. When comparing "Luteal" to "Conventional," clinically relevant differences in MII oocytes were ruled out in all subgroups. We found that "Luteal" probably increases the COH length both, in the general infertile population (OR 2.00 days, 95% CI 0.81 to 3.19, moderate-quality evidence) and in oocyte freezing cycles (MD 0.85 days, 95% CI 0.53 to 1.18, moderate-quality evidence). When analyzing DuoStim among poor responders, we found that it appears to generate a higher number of MII oocytes in comparison with a single "Conventional" (MD 3.35, 95%CI 2.54-4.15, moderate-quality evidence).

Conclusion: Overall, this systematic review of the available data demonstrates that in poor responders, general infertile population and oocyte freezing for cancer stimulation in the late follicular and luteal phases can be utilized in non-conventional approaches such as random-start and DuoStim cycles, offering similar outcomes to the conventional cycles but potentially with increased flexibility, within a reduced time frame. However, more well-designed trials are required to establish certainty.

Keywords: Double ovarian stimulation; DuoStim; Luteal-phase stimulation; Random-start ovarian stimulation; Systematic review.

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Conflict of interest statement

The authors declare that they have no conflicts of interest.

Figures

Fig. 1
Fig. 1
Flowchart for study selection. Description of the illustration: PRISMA flowchart
Fig. 2
Fig. 2
Assessment of risk of bias across observational studies
Fig. 3
Fig. 3
MII oocyte retrieval in LPS and eFPS. Description of the illustration: Sensitivity analysis including best quality studies fails to show any clinically significant
Fig. 4
Fig. 4
Ovarian stimulation length in LPS and eFPS. Description of the illustration: Sensitivity analysis including best quality studies in normo-responders shows that LPS may be some longer than eFPS
Fig. 5
Fig. 5
MII oocyte retrieval in double stimulation and eFPS. Description of the illustration: Double stimulation probably increases the number of MII oocytes in comparison with eFPS
See this image and copyright information in PMC

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