來曲唑聯合拮抗劑方案對體外受精-胚胎移植中低反應患者有效性的Meta分析_《中國循證醫學雜志》

作者：

孫琴 , 陳莉 , 邵一丹 , 姚兵 ,  梁元姣

南京軍區南京總醫院生殖醫學中心（南京 210000）;

關鍵詞：

來曲唑 GnRHA 卵巢低反應體外受精-胚胎移植系統評價 Meta分析

DOI：

10.7507/1672-2531.20130232

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目的　系統評價來曲唑+促性腺激素釋放激素拮抗劑方案對體外受精-胚胎移植（IVF-ET）中低反應患者促排卵的有效性。
方法　計算機檢索VIP、CNKI、PubMed、EMbase和FMJS，收集有關來曲唑+拮抗劑方案對體外受精-胚胎移植低反應患者促排卵有效性的隨機對照試驗或臨床對照試驗。由2位評價員根據納入與排除標準獨立進行文獻篩選、資料提取和質量評價后，采用RevMan 5.0軟件進行Meta分析。
結果　最終納入6個研究，共977例患者。Meta分析結果顯示：對體外受精-胚胎移植中低反應患者，來曲唑+拮抗劑方案與對照組相比，Gn用量［MD= –8.05，95%CI（–13.67，–2.43），P=0.005］、HCG日E2值［MD= –1 026.41，95%CI（–1 949.61，–103.20），P=0.03］均小于對照組；而兩組獲卵數［MD= –0.61，95%CI（–2.41，–1.19），P=0.51］和臨床妊娠率［OR=1.03，95%CI（0.53，2.02），P=0.92］無明顯差異。
結論　對IVF-ET低反應患者促排卵治療的有效性而言，來曲唑+拮抗劑方案較對照組臨床結局無明顯改善，但能減少Gn用量，降低IVF治療費用。來曲唑+拮抗劑方案為卵巢低反應患者提供了另一種臨床選擇。由于納入文獻存在質量和數量不足以及方法學差異，建議本研究結論僅作為臨床分析的參考，尚需后效評價和不斷更新。

引用本文： 孫琴,陳莉,邵一丹,姚兵,梁元姣. 來曲唑聯合拮抗劑方案對體外受精-胚胎移植中低反應患者有效性的Meta分析. 中國循證醫學雜志, 2013, 13(11): 1354-1360. doi: 10.7507/1672-2531.20130232 復制

1.	Sunkara SK, Tuthill J, Khairy M, et al. Pituitary suppression regimens in poor responders undergoing IVF treatment: a systematic review and meta-analysis. Reprod Biomed Online, 2007, 150(5): 539-546.
2.	Keay SD, Liversedge NH, Mathur RS, et al. Assisted conception following poor ovarion res-ponse to stimulation for IVF: a systematic review. British J Obestet and Gynecol, 1997, 104(5): 521-528.
3.	Zhen XM, Qiao J, Li R, et al. The clinical analysis of poor ovarian response in vitro fertil-izaliton embryo transfer among Chinese couples. Assist Reprod Genet, 2008, 25(1): 17-22.
4.	Mahutte NG, Arici A. Role of gonadotropin-releasing hormone antagonists in poor responders. Fertil Sterl, 2007, 87(2): 241-249.
5.	肖勁松, 陳雙隕, 張春蓮, 等. GnRH-拮抗劑對體外受精-胚胎移植中低反應患者有效性的系統性評價. 現代婦產科進展, 2011, 120(14): 300-306.
6.	Ferraretti AP, La Marca A, Fauser BC, et al. ESHRE consensus on the definition of poor response to ovarian stimulation for in vitro fertilization: the Bologna criteria. Hum Reprod, 2011, 26(7): 1616-1624.
7.	Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions. Version 5.1.0. 2011. Available from: www.cochrane-handbook.org.
8.	Davar R, Oskouian H, Ahmadi S, et al. GnRH antagonist/letrozole versus microdose GnRH agonist flare protocol in poor responders undergoing in vitro fertilization. Taiwan J Obstet Gynecol, 2010, 49(3): 297-301.
9.	Garcia-Velasco JA, Moreno L, Pacheco A, et al. The aromatase inhibitor letrozole increases the concentration of intraovarian androgens and improves in vitro fertilization outcome in low responder patients: a pilot study. Fertil Steril, 2005, 84(1): 82-87.
10.	Ozmen B, Sonmezer M, Atabekoglu CS, et al. Use of aromatase inhibitors in poor-responder patients receiving GnRH antagonist protocols. Reprod Biomed Online, 2009, 19(4): 478-485.
11.	Schoolcraft WB, Surrey ES, Minjarez DA, et al. Management of poor responders: can outcomes be im-proved with a novel gonadotropin-releasing hormone antagonist/letrozole protocol? Fertil Steril, 2008, 89(1): 151-156.
12.	Lee VCY, Chan CC, Ng EHY, et al. Sequential use of letrozole and gonadotrophin in women with poor ovarian reserve: a randomized controlled trial. Reprod Biomed Online, 2011, 23(2): 380-388.
13.	夏歡, 孫麗君, 王興玲, 等. 來曲唑微刺激促排卵方案在卵巢低反應患者中的應用. 中國婦幼保健, 2011, 26(30): 4725-4728.
14.	葉碧綠, 葉練. 芳香化酶抑制劑在誘導排卵中的應用. 生殖醫學雜志, 2005, 14(6): 374-377.
15.	Thiruppathi P, Shatavi S, Dias JA, et al. Gonadotrophin receptor expression on human gran-ulosa cells of low and normal responders to FSH. Mol Hum Reprod, 2001, 7(3): 697-704.
16.	Weil S, Vendola K, Zhou J, et al. Androgen and follicle stimulating hormone interactions in primate ovarian follicle development. Clin Endocr Metab, 1999, 84(8): 2951-2956.
17.	劉蕓, 刑福琪, 何凌云, 等. 芳香化酶抑制劑在卵巢低反應者超促排卵中的作用. 南方醫科大學學報, 2009, 29(3): 559-561.
18.	Ficicioglu C, Kutlu T, Baglam E, et al. Early follicular and anti-mullerian hormone as an indicator of ovarian reserve. Feritil Steril, 2006, 85(3): 592-596.
19.	Kevenaar ME, Meerasahib MF, Kramer P, et al. Serum anti-mullerian hormone levels reflect the size of the primordial follicle pool in mice. Endocrinology, 2006, 147(7): 3228-3234.
20.	Cortinez A, De Carvalho I, Vantman D, et al. Hormonal profile and endometrial morph-ology in letrozle-controlled ovarian hyper-stimulation in ovulatory infertile patients. Fertil Steril, 2005, 83(1): 110-115.
21.	Sunkara SK, Pundir J, Kalaf Y. Effect of androgen supplementation or modulation on ovarion stimulation outcome in poor responders: a meta-analysis. Reprod Biomed Online, 2011, 22(2): 545-555.
22.	Kupesic S, Kurjak A, Bjelos D, et al. Three-dimensional ultrasonographic ovarian measure-ments and in vitro fertilization outcome are related to age. Fertil Steril, 2003, 79(1): 190-197.

1. Sunkara SK, Tuthill J, Khairy M, et al. Pituitary suppression regimens in poor responders undergoing IVF treatment: a systematic review and meta-analysis. Reprod Biomed Online, 2007, 150(5): 539-546.
2. Keay SD, Liversedge NH, Mathur RS, et al. Assisted conception following poor ovarion res-ponse to stimulation for IVF: a systematic review. British J Obestet and Gynecol, 1997, 104(5): 521-528.
3. Zhen XM, Qiao J, Li R, et al. The clinical analysis of poor ovarian response in vitro fertil-izaliton embryo transfer among Chinese couples. Assist Reprod Genet, 2008, 25(1): 17-22.
4. Mahutte NG, Arici A. Role of gonadotropin-releasing hormone antagonists in poor responders. Fertil Sterl, 2007, 87(2): 241-249.
5. 肖勁松, 陳雙隕, 張春蓮, 等. GnRH-拮抗劑對體外受精-胚胎移植中低反應患者有效性的系統性評價. 現代婦產科進展, 2011, 120(14): 300-306.
6. Ferraretti AP, La Marca A, Fauser BC, et al. ESHRE consensus on the definition of poor response to ovarian stimulation for in vitro fertilization: the Bologna criteria. Hum Reprod, 2011, 26(7): 1616-1624.
7. Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions. Version 5.1.0. 2011. Available from: www.cochrane-handbook.org.
8. Davar R, Oskouian H, Ahmadi S, et al. GnRH antagonist/letrozole versus microdose GnRH agonist flare protocol in poor responders undergoing in vitro fertilization. Taiwan J Obstet Gynecol, 2010, 49(3): 297-301.
9. Garcia-Velasco JA, Moreno L, Pacheco A, et al. The aromatase inhibitor letrozole increases the concentration of intraovarian androgens and improves in vitro fertilization outcome in low responder patients: a pilot study. Fertil Steril, 2005, 84(1): 82-87.
10. Ozmen B, Sonmezer M, Atabekoglu CS, et al. Use of aromatase inhibitors in poor-responder patients receiving GnRH antagonist protocols. Reprod Biomed Online, 2009, 19(4): 478-485.
11. Schoolcraft WB, Surrey ES, Minjarez DA, et al. Management of poor responders: can outcomes be im-proved with a novel gonadotropin-releasing hormone antagonist/letrozole protocol? Fertil Steril, 2008, 89(1): 151-156.
12. Lee VCY, Chan CC, Ng EHY, et al. Sequential use of letrozole and gonadotrophin in women with poor ovarian reserve: a randomized controlled trial. Reprod Biomed Online, 2011, 23(2): 380-388.
13. 夏歡, 孫麗君, 王興玲, 等. 來曲唑微刺激促排卵方案在卵巢低反應患者中的應用. 中國婦幼保健, 2011, 26(30): 4725-4728.
14. 葉碧綠, 葉練. 芳香化酶抑制劑在誘導排卵中的應用. 生殖醫學雜志, 2005, 14(6): 374-377.
15. Thiruppathi P, Shatavi S, Dias JA, et al. Gonadotrophin receptor expression on human gran-ulosa cells of low and normal responders to FSH. Mol Hum Reprod, 2001, 7(3): 697-704.
16. Weil S, Vendola K, Zhou J, et al. Androgen and follicle stimulating hormone interactions in primate ovarian follicle development. Clin Endocr Metab, 1999, 84(8): 2951-2956.
17. 劉蕓, 刑福琪, 何凌云, 等. 芳香化酶抑制劑在卵巢低反應者超促排卵中的作用. 南方醫科大學學報, 2009, 29(3): 559-561.
18. Ficicioglu C, Kutlu T, Baglam E, et al. Early follicular and anti-mullerian hormone as an indicator of ovarian reserve. Feritil Steril, 2006, 85(3): 592-596.
19. Kevenaar ME, Meerasahib MF, Kramer P, et al. Serum anti-mullerian hormone levels reflect the size of the primordial follicle pool in mice. Endocrinology, 2006, 147(7): 3228-3234.
20. Cortinez A, De Carvalho I, Vantman D, et al. Hormonal profile and endometrial morph-ology in letrozle-controlled ovarian hyper-stimulation in ovulatory infertile patients. Fertil Steril, 2005, 83(1): 110-115.
21. Sunkara SK, Pundir J, Kalaf Y. Effect of androgen supplementation or modulation on ovarion stimulation outcome in poor responders: a meta-analysis. Reprod Biomed Online, 2011, 22(2): 545-555.
22. Kupesic S, Kurjak A, Bjelos D, et al. Three-dimensional ultrasonographic ovarian measure-ments and in vitro fertilization outcome are related to age. Fertil Steril, 2003, 79(1): 190-197.

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來曲唑聯合拮抗劑方案對體外受精-胚胎移植中低反應患者有效性的Meta分析

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《中國循證醫學雜志》

來曲唑聯合拮抗劑方案對體外受精-胚胎移植中低反應患者有效性的Meta分析

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