GnRH agonist and hCG (dual trigger) versus hCG trigger for follicular maturation: a systematic review and meta-analysis of randomized trials.
GnRH agonist and hCG (dual trigger) versus hCG trigger for follicular maturation: a systematic review and meta-analysis of randomized trials.
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GnRH 激动剂和 hCG（双触发）与 hCG 触发卵泡成熟：随机试验的系统评价和荟萃分析
DOI：
10.1186/s12958-021-00766-5
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发表时间：
2021-06-01
期刊：
影响因子：
--
通讯作者：
Hunt S
中科院分区：
文献类型：
--
作者：
Hu KL;Wang S;Ye X;Zhang D;Hunt S
传统上，最终卵泡成熟是由单次推注人绒毛膜促性腺激素 (hCG) 触发的。它可以替代自然发生的黄体生成素 (LH) 激增，诱导颗粒细胞黄体化、恢复减数分裂和最终卵母细胞成熟。最近，有人建议将促性腺激素释放激素 (GnRH) 激动剂与 hCG（双触发）联合推注作为实现卵泡最终成熟的替代方案。本研究是对随机试验的系统回顾和荟萃分析，评估双重触发与 hCG 触发对卵泡成熟对接受体外受精 (IVF) 的女性妊娠结局的影响。主要结局是每个开始周期的活产率（LBR）。分析共有 1048 名参与者，其中双触发组 519 名，hCG 触发组 529 名。与 hCG 触发治疗相比，双触发治疗与每个开始周期的 LBR 显着升高相关（风险比 (RR) = 1.37 [1.07, 1.76]，I2 = 0%，中等证据）。与 hCG 触发治疗相比，双触发治疗的持续妊娠率（RR = 1.34 [0.96, 1.89]，I2 = 0%，低证据）和着床率（RR = 1.31 [0.90, 1.91]，I2 = 76%，低证据）均呈增加趋势。双触发治疗与临床妊娠率（RR = 1.29 [1.10, 1.52]，I2 = 13%，低证据）、收集的卵母细胞数量（平均差 (MD) = 1.52 [0.59, 2.46)，I2 = 53%，低证据）、收集的成熟卵母细胞数量的显着增加相关（MD = 1.01 [0.43, 1.58]，I2 = 18%，低证据），受精卵母细胞数量（MD = 0.73 [0.16, 1.30]，I2 = 7%，低证据）和明显更多的可用胚胎（MD = 0.90 [0.42， 1.38]，I2 = 0%，低证据）。与传统 hCG 触发剂相比，GnRH 激动剂和 HCG 双重触发治疗可提高活产率。 CRD42020204452。在线版本包含可在 10.1186/s12958-021-00766-5 获取的补充材料。
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. 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. 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). Dual trigger treatment with GnRH agonist and HCG is associated with an increased live birth rate compared with conventional hCG trigger. CRD42020204452. The online version contains supplementary material available at 10.1186/s12958-021-00766-5.
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