Gonadotrophin-releasing hormone antagonists for assisted reproductive technology in women with poor ovarian response. Subgroup analysis of Cochrane systematic review and meta-analysis

Abstract

Background: Treatment of women with poor ovarian response during IVF/ICSI treatment is so complicated. Most of treatment protocols used lead to more cost without improvement in pregnancy rate. The aim of the present subgroup analysis was to evaluate the efficacy of GnRH antagonist in poor responders.

Methods: We conducted a systematic review and meta-analysis of randomized trials comparing the effect of GnRH agonist versus GnRH antagonist in poor responders undergoing IVF/ICSI cycles.

Outcomes: primary outcome was ongoing pregnancy rate while the Secondary outcomes was clinical pregnancy rate, miscarriage rate, duration of stimulation, amount of FSH, number of retrieved oocytes, number of mature oocytes and cancellation rate. Searches (until Sep. 2010) were conducted in MEDLINE, EMBASE, Science Direct, Cochrane Library and databases of abstracts.

Results: Six randomized trials entailing 919 women were included. There was no evidence of a statistically significant difference in ongoing pregnancy rate (3 RCTs; OR: 1.17, 95% CI 0.53 to 2.58) for GnRH antagonist versus long GnRH agonist protocol.

Conclusion: In view of its equivalence, GnRH antagonist protocol for pituitary desensitization is an alternative for standard long GnRH agonist protocol in poor responder patients undergoing IVF/ICSI treatment cycles.