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10.01.2021 | Gynecologic Endocrinology and Reproductive Medicine

Meta-analysis of GnRH-antagonists versus GnRH-agonists in poor responder protocols

verfasst von: Myrto Papamentzelopoulou, Sofoklis Stavros, Despoina Mavrogianni, Christos Kalantzis, Dimitrios Loutradis, Petros Drakakis

Erschienen in: Archives of Gynecology and Obstetrics | Ausgabe 2/2021

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Abstract

Purpose

Considering the insufficient evidence supporting an ideal protocol for poor responder management in IVF/ICSI cycles, the aim of the current meta-analysis was to compare GnRH-antagonist versus GnRH-agonist protocols in poor responders, evaluating effectiveness and safety.

Methods

Meta-analysis was conducted using Medcalc 16.8 version software. Standardized mean differences (SMD), odds ratios (OR), and the respective 95% confidence intervals (CI) were determined appropriately. The Cochran Q statistic and the I² test were used to assess studies’ heterogeneity.

Results

GnRH-agonists were shown to correlate with fewer cancelled IVF/ICSI cycles (p = 0.044, OR = 1.268 > 1, 95% CI 1.007, 1.598), a larger number of embryos transferred (p = 0.008, SMD = − 0.230, 95% CI − 0.400, − 0.0599), and more clinical pregnancies (p = 0.018, OR = 0.748 < 1, 95% CI 0.588, 0.952). However, GnRH-antagonists resulted in a significantly shorter duration of ovarian stimulation (p = 0.007, SMD = − 0.426. 95% CI − 0.736, − 0.115). The number of oocytes and mature oocytes retrieved in both protocols did not differ statistically (p = 0.216, SMD = − 0.130, 95% CI − 0.337, 0.0763 and p = 0.807, SMD = − 0.0203, 95% CI − 0.183, 0.142, respectively). Moreover, a high heterogeneity among studies was observed regarding duration of ovarian stimulation (I² = 90.6%), number of oocytes (I² = 82.83%)/mature oocytes retrieved (I² = 70.39%), and embryos transferred (I² = 72.83%).

Conclusions

Based on the present meta-analysis, agonist protocols could be suggested as a first choice approach, in terms of effectiveness. Due to the high studies’ heterogeneity, results should be considered with caution. Accordingly, larger cohort studies and meta-analyses like the present one will enhance the robustness of the emerging results to identify the ideal protocol for poor responders.

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Titel: Meta-analysis of GnRH-antagonists versus GnRH-agonists in poor responder protocols
verfasst von: Myrto Papamentzelopoulou
Sofoklis Stavros
Despoina Mavrogianni
Christos Kalantzis
Dimitrios Loutradis
Petros Drakakis
Publikationsdatum: 10.01.2021
Verlag: Springer Berlin Heidelberg
Erschienen in: Archives of Gynecology and Obstetrics / Ausgabe 2/2021
Print ISSN: 0932-0067
Elektronische ISSN: 1432-0711
DOI: https://doi.org/10.1007/s00404-020-05954-z

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Meta-analysis of GnRH-antagonists versus GnRH-agonists in poor responder protocols