Among patients treated for IVF with gonadotrophins and GnRH analogues, is the probability of live birth dependent on the type of analogue used? A systematic review and meta-analysis

Abstract Background Traditionally, final follicular maturation is triggered by a single bolus of human chorionic gonadotropin (hCG). This acts as a surrogate to the naturally occurring luteinizing hormone (LH) surge to induce luteinization of the granulosa cells, resumption of meiosis and final oocyte maturation. More recently, a bolus of gonadotropin-releasing hormone (GnRH) agonist in combination with hCG (dual trigger) has been suggested as an alternative regimen to achieve final follicular maturation. Methods This study was a systematic review and meta-analysis of randomized trials evaluating the effect of dual trigger versus hCG trigger for follicular maturation on pregnancy outcomes in women undergoing in vitro fertilization (IVF). The primary outcome was the live birth rate (LBR) per started cycle. Results A total of 1048 participants were included in the analysis, with 519 in the dual trigger group and 529 in the hCG trigger group. Dual trigger treatment was associated with a significantly higher LBR per started cycle compared with the hCG trigger treatment (risk ratio (RR) = 1.37 [1.07, 1.76], I2 = 0%, moderate evidence). There was a trend towards an increase in both ongoing pregnancy rate (RR = 1.34 [0.96, 1.89], I2 = 0%, low evidence) and implantation rate (RR = 1.31 [0.90, 1.91], I2 = 76%, low evidence) with dual trigger treatment compared with hCG trigger treatment. Dual trigger treatment was associated with a significant increase in clinical pregnancy rate (RR = 1.29 [1.10, 1.52], I2 = 13%, low evidence), number of oocytes collected (mean difference (MD) = 1.52 [0.59, 2.46), I2 = 53%, low evidence), number of mature oocytes collected (MD = 1.01 [0.43, 1.58], I2 = 18%, low evidence), number of fertilized oocytes (MD = 0.73 [0.16, 1.30], I2 = 7%, low evidence) and significantly more usable embryos (MD = 0.90 [0.42, 1.38], I2 = 0%, low evidence). Conclusion Dual trigger treatment with GnRH agonist and HCG is associated with an increased live birth rate compared with conventional hCG trigger. Trial registration CRD42020204452.

Download Full-text

Dienogest versus gonadotropin-releasing hormone analogue for the clinical treatment of endometriosis: a systematic review and meta-analysis

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20174013 ◽

2017 ◽

Vol 6 (9) ◽

pp. 3712

Author(s):

Sofia Andrade De Oliveira ◽

Bárbara Souza Melo ◽

Marina Fernandes Pereira

Keyword(s):

Systematic Review ◽

Pelvic Pain ◽

Meta Analysis ◽

Uterine Cavity ◽

Lower Abdominal Pain ◽

Gnrh Analogue ◽

Hot Flushes ◽

Gnrh Analogues ◽

Great Loss ◽

Pouch Of Douglas

Endometriosis is a chronic inflammatory disease, defined by the presence of endometrial tissue outside the uterine cavity. It causes symptoms such as dysmenorrhea, chronic pelvic pain, dyspareunia, infertility, with great loss of quality of life for the patient. The objective of the study was to compare, through a meta-analysis, GnRH analogues, which are considered clinical first line treatment for endometriosis, versus dienogest, a selective oral progestin in the treatment of endometriosis. A systematic review was conducted to select the studies. In total, 31 articles were found. Four studies met criteria, the following variables were analyzed: pelvic pain, dyspareunia and induration of the Pouch of Douglas after treatment and it was evaluated the presence of side effects during treatment: hot flushes, headache and BMD loss. There was no difference between the dienogest group and GnRH analogue group when it was evaluated maintenance of lower abdominal pain, dyspareunia, induration of the Pouch of Douglas after treatment and hot flushes during treatment. Besides those results, the dienogest group had a lower incidence of headache and less BMD loss. The treatment of endometriosis continues to be a challenge, even with new treatment options such as new drugs (dienogest) and surgical procedures. This meta-analysis provides evidence of the absence of dienogest inferiority compared with GnRH analogues with less BMD loss and less headache incidence.

Download Full-text