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Effectiveness of GnRH antagonist in the management of subfertile couples undergoing controlled ovarian stimulation and intrauterine insemination: a meta-analysis.


ABSTRACT:

Background

Recent studies have indicated the use of gonadotropin-releasing hormone antagonists (GnRH-ant) as an adjuvant treatment to prevent premature luteinization (PL) and improve the clinical outcomes in patients undergoing controlled ovarian stimulation (COS) with intrauterine insemination (IUI). However, the results of these studies are conflicting.

Methods

We conducted a systematic review and meta-analysis of randomized trials aiming to compare the clinical efficacy of GnRH-ant in COS/IUI cycles. Twelve studies were identified that met inclusion criteria and comprised 2,577 cycles assigned to COS/IUI combined GnRH-ant or COS/IUI alone.

Results

Meta-analysis results suggested that GnRH-ant can significantly increase the clinical pregnancy rate (CPR) (OR?=?1.42; 95% CI, 1.13-1.78) and decrease the PL rate (OR?=?0.22, 95% CI, 0.16-0.30) in COS/IUI cycles. Subgroup analysis results suggested statistically significant improvement in the CPR in non-PCOS patients (OR?=?1.54; 95% CI, 1.03-2.31) but not in the PCOS population (OR?=?1.65; 95% CI, 0.93-2.94) and multiple mature follicle cycles (OR?=?1.87; 95% CI, 0.27-12.66). There were no difference in the miscarriage and multiple pregnancy rates between the groups.

Conclusion

This meta-analysis suggested that GnRH-ant can reduce the incidence of PL and increase the CPR when used in COS/IUI cycles, and it was especially useful for non-PCOS patients. However, evidence to support its use in PCOS patients is still insufficient.

SUBMITTER: Luo S 

PROVIDER: S-EPMC4192303 | biostudies-literature | 2014

REPOSITORIES: biostudies-literature

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Publications

Effectiveness of GnRH antagonist in the management of subfertile couples undergoing controlled ovarian stimulation and intrauterine insemination: a meta-analysis.

Luo Shan S   Li Shangwei S   Jin Song S   Li Ya Y   Zhang Yaoyao Y  

PloS one 20141009 10


<h4>Background</h4>Recent studies have indicated the use of gonadotropin-releasing hormone antagonists (GnRH-ant) as an adjuvant treatment to prevent premature luteinization (PL) and improve the clinical outcomes in patients undergoing controlled ovarian stimulation (COS) with intrauterine insemination (IUI). However, the results of these studies are conflicting.<h4>Methods</h4>We conducted a systematic review and meta-analysis of randomized trials aiming to compare the clinical efficacy of GnRH  ...[more]

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