辅助生殖技术促激素拮抗剂。

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Al-Inany HG,优素福妈,Ayeleke RO、棕色J,林WS, Broekmans陆地

辅助生殖技术促激素拮抗剂。

Cochrane数据库系统启2016年4月29日,4:CD001750。cd001750.pub4 doi: 10.1002/14651858.。

PubMed ID
27126581 (在PubMed
]
文摘

背景:促激素(促)拮抗剂可以用来防止促黄体激素(LH)飙升期间控制卵巢过度刺激正没有hypo-oestrogenic副作用,冲突,或者长期下调与受体激动剂有关。对手直接和快速抑制促性腺激素释放在几个小时内通过竞争结合垂体促性腺激素受体。这个属性允许他们使用在任何时候在卵泡期。描述了几种不同的方案,包括multiple-dose固定(0.25毫克每日从6到7天的刺激),multiple-dose灵活(0.25毫克每日当领导卵泡是14到15毫米),和单剂(单管理3毫克7到8天的刺激)协议,有或没有的口服避孕药。此外,女性接受拮抗剂已被证明有卵巢过度刺激综合征的发生率较低(主要)。假设拮抗剂和激动剂协议类似的临床结果,这些好处将证明改变从标准长拮抗剂受体激动剂协议方案。这是一个更新的Cochrane回顾在2001年首次出版,和此前在2006年和2011年更新。目的:评估的有效性和安全促激素(促)拮抗剂与标准的长期协议控制卵巢过度刺激促性腺激素受体激动剂的辅助概念周期。必威国际app搜索方法:我们搜查了Cochrane月经失调和Subfertility组试验注册(搜索从开始到2015年5月),科克伦中央登记的对照试验(中央)(Cochrane图书馆,开始到2015年4月28日),奥维德MEDLINE(1966年至2015年4月28日),EMBASE(1980年至2015年4月28日),PsycINFO(1806年至2015年4月28日),CINAHL(2015年4月28日)和试验注册,2015年4月28日,和handsearched书目的相关出版物和评论,和主要科学会议的摘要,例如欧洲人类生殖及胚胎学会(次于)和美国生殖医学协会(ASRM)。我们的作者联系合格的研究缺失或未发表的数据。 The evidence is current to 28 April 2015. SELECTION CRITERIA: Two review authors independently screened the relevant citations for randomised controlled trials (RCTs) comparing different GnRH agonist versus GnRH antagonist protocols in women undergoing in vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI). DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trial eligibility and risk of bias, and extracted the data. The primary review outcomes were live birth and ovarian hyperstimulation syndrome (OHSS). Other adverse effects (miscarriage and cycle cancellation) were secondary outcomes. We combined data to calculate pooled odds ratios (ORs) and 95% confidence intervals (CIs). Statistical heterogeneity was assessed using the I(2) statistic. We assessed the overall quality of the evidence for each comparison using GRADE methods. MAIN RESULTS: We included 73 RCTs, with 12,212 participants, comparing GnRH antagonist to long-course GnRH agonist protocols. The quality of the evidence was moderate: limitations were poor reporting of study methods.Live birthThere was no conclusive evidence of a difference in live birth rate between GnRH antagonist and long course GnRH agonist (OR 1.02, 95% CI 0.85 to 1.23; 12 RCTs, n = 2303, I(2)= 27%, moderate quality evidence). The evidence suggested that if the chance of live birth following GnRH agonist is assumed to be 29%, the chance following GnRH antagonist would be between 25% and 33%.OHSSGnRH antagonist was associated with lower incidence of any grade of OHSS than GnRH agonist (OR 0.61, 95% C 0.51 to 0.72; 36 RCTs, n = 7944, I(2) = 31%, moderate quality evidence). The evidence suggested that if the risk of OHSS following GnRH agonist is assumed to be 11%, the risk following GnRH antagonist would be between 6% and 9%.Other adverse effectsThere was no evidence of a difference in miscarriage rate per woman randomised between GnRH antagonist group and GnRH agonist group (OR 1.04, 95% CI 0.82 to 1.30; 33 RCTs, n = 7022, I(2) = 0%, moderate quality evidence).With respect to cycle cancellation, GnRH antagonist was associated with a lower incidence of cycle cancellation due to high risk of OHSS (OR 0.47, 95% CI 0.32 to 0.69; 19 RCTs, n = 4256, I(2) = 0%). However cycle cancellation due to poor ovarian response was higher in women who received GnRH antagonist than those who were treated with GnRH agonist (OR 1.32, 95% CI 1.06 to 1.65; 25 RCTs, n = 5230, I(2) = 68%; moderate quality evidence). AUTHORS' CONCLUSIONS: There is moderate quality evidence that the use of GnRH antagonist compared with long-course GnRH agonist protocols is associated with a substantial reduction in OHSS without reducing the likelihood of achieving live birth.

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