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Meta-Analysis
. 2021 Aug;38(8):1927-1938.
doi: 10.1007/s10815-021-02237-7. Epub 2021 May 25.

ART outcomes following ovarian stimulation in the luteal phase:a systematic review and meta-analysis

Buo-Jia Lu  1 , Chien-Ju Lin  2 , Bou-Zenn Lin  3 , Li Huang  4 , Li-Ting Chien  5 , Chi-Huang Chen  6   7
Affiliations
Meta-Analysis

ART outcomes following ovarian stimulation in the luteal phase:a systematic review and meta-analysis

Buo-Jia Lu et al. J Assist Reprod Genet. 2021 Aug.

Abstract

Purpose: This study aimed to evaluate the impact of luteal phase ovarian stimulation (LPS) on the outcomes of assisted reproductive technology (ART) for infertile couples and patients desiring non-urgent egg cryopreservation.

Methods: We included all studies reported patients who received LPS and that used follicular phase ovarian stimulation (FPS) as a comparison group until January 2021. Prior meta-analysis regarding the outcomes of LPS in double stimulation and fertility preservation have already been published, so these studies were excluded. Risk of Bias in Non-randomized Studies of Interventions was used to assess the study quality. The study was registered in the International Prospective Register of Systematic Reviews database (CRD42020183946).

Results: Twelve studies with a total of 4433 patients were included. The regimen employed can be categorized into two groups, but there is currently no evidence to support one over the other. After we excluded the largest study, the clinical pregnancy rate and live birth rate were similar after FPS and LPS. There were significantly more stimulation days and total gonadotropins used in the LPS group. After subgroup analysis, we found that poor responders received significantly more cumulus oocyte complexes (+0.64) in the LPS group.

Conclusion: Current evidence indicates that patients in the LPS group could achieve pregnancy outcomes non-inferior to those in the FPS group. Because of current debate over freeze-all policy and the limited data about live birth rate, the universal use of LPS is considered controversial. In the future, more well-designed studies are necessary to investigate the indications for LPS and its cost-effectiveness.

Keywords: Luteal phase; Ovarian stimulation; Poor responders; Random start.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
The study selection flowchart. CDSR, Cochrane Database of Systematic Reviews; FPS, follicular phase ovarian stimulation; LPS, luteal phase ovarian stimulation
Fig. 2
Fig. 2
Forest plot of A stimulation duration and B total dose of gonadotropins, divided into two subgroups according to normal or poor responders, and compared patients undergoing LPS with patients undergoing FPS. Abbreviation: SD, standard deviation; MD, mean difference; CI, confidence interval; FPS, follicular phase stimulation; LPS, luteal phase stimulation
Fig. 3
Fig. 3
Forest plot of A total cumulus oocyte complex retrieved and B embryos viable for transfer, divided into two subgroups according to normal or poor responders, and compared patients undergoing LPS with patients undergoing FPS. Abbreviation: SD, standard deviation; MD, mean difference; CI, confidence interval; FPS, follicular phase stimulation; LPS, luteal phase stimulation
Fig. 4
Fig. 4
A Forest plot of clinical pregnancy rate per transfer, and compared patients undergoing LPS with patients undergoing FPS. B Forest plot of clinical pregnancy rate per transfer after we excluded one largest study by Wang et al. C Forest plot of live birth rate per transfer, and compared patients undergoing LPS with patients undergoing FPS. D Forest plot of live birth rate per transfer after we excluded one largest study by Wang et al. Abbreviation: CI, confidence interval; LOR, logarithms of the odds ratio; OR, odds ratio; se, standard error; FPS: follicular phase ovarian stimulation; LPS: luteal phase ovarian stimulation
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