Recombinant versus urinary gonadotrophin for ovarian stimulation in assisted reproductive technology cycles. A Cochrane review.
نویسندگان
چکیده
BACKGROUND Several systematic reviews compared recombinant gonadotrophin with urinary gonadotrophins (HMG, purified FSH, highly purified FSH) for ovarian hyperstimulation in IVF and ICSI cycles and these reported conflicting results. Each of these reviews used different inclusion and exclusion criteria for trials. Our aim in producing this review is to bring together all randomised studies in this field under common inclusion criteria with consistent and valid statistical methods. OBJECTIVES To compare the effectiveness of recombinant gonadotrophin (rFSH) with the three main types of urinary gonadotrophins (i.e. HMG, FSH-P and FSH-HP) for ovarian stimulation in women undergoing IVF or ICSI treatment cycles. SEARCH STRATEGY An extended search was done according to Cochrane guidelines including the Menstrual Disorders & Subfertility Group's Specialised Register of controlled trials, The Cochrane Central Register of Controlled Trials, MEDLINE (1966 to May 2010), EMBASE (1980 to May 2010), CINAHL (1982 to May 2010), National Research Register, and Current Controlled Trials. SELECTION CRITERIA All randomised controlled trials reporting data comparing clinical outcomes for women undergoing IVF/ICSI cycles and using recombinant FSH in comparison with HMG or highly purified HMG, purified urinary FSH (FSH-P), and highly purified urinary FSH (FSH-HP) for ovarian hyperstimulation in IVF or ICSI cycles were included. DATA COLLECTION AND ANALYSIS Primary outcome measure was live birth rate and OHSS per randomised woman.Binary outcomes were analysed using odds ratios and also reported in absolute terms. Grouped analyses were carried out for all outcomes to explore whether relative effects differed due to key features of the trials. MAIN RESULTS We included 42 trials with a total of 9606 couples. Comparing rFSH to any of the other gonadotrophins irrespective of the down-regulation protocol used, did not result in any evidence of a statistically significant difference in live birth rate (28 trials, 7339 couples, odds ratio 0.97, 95% CI 0.87 to 1.08). This suggests that for a group with a 25% live birth rate using urinary gonadotrophins the rate would be between 22.5% and 26.5% using rFSH. There was also no evidence of a difference in the OHSS rate (32 trials, 7740 couples, OR 1.18, 95% CI 0.86 to 1.61). This means that for a group with 2% risk of OHSS using urinary gonadotrophins, the risk would be between 1.7% and 3.2% using rFSH. AUTHORS' CONCLUSIONS Clinical choice of gonadotrophin should depend on availability, convenience and costs. Further research on these comparisons is unlikely to identify substantive differences in effectiveness or safety.
منابع مشابه
I-27: Management of Poor Responders:Current and Past Recommended Strategy
The management of poor responders in IVF cycles is extremely controversial due to their inadequate response to controlled ovarian hyperstimulation.. A low ovarian response may be idiopathic or may be associated with many different factors including age, diminished ovarian reserve, endometriosis and prior ovarian surgery, and a reported incidence 9-24% of IVF patients. Several strategies have be...
متن کاملP-228: Low Dose HCG Adjunct to r-hFSH/GnRH Antagonist for Controlled Ovarian Stimulation in Assisted Reproductive Technology: A Prospective and Randomized Trial
Background: Deep suppression of LH in GnRH antagonist cycles may have detrimental effect on reproductive out come. It was hypnotized that adding LH activity via the administration of low dose HCG in late follicular phase shortened the duration of stimulation, decreased consumption of gonadotropin and increased estrogen levels. This study was designed to evaluate the effect of adding low dose HC...
متن کاملP-165: Results of Adding Recombinant LH in Normoresponder Patients for Assisted Reproductive Technology Treatment: A Prospective Randomized Control Trial
Background: Based on classical two cell- two-gonadotropin theory, in the follicle, FSH and LH put on their main effects on the granulosa and theca cells. LH is essential for androgens production. Androgens as precursor, is used for estradiol production by granulosa cells under aromatase activity. Profound suppression of LH concentrations in some normogonadotropic patients can cause several adve...
متن کاملEfficacy of Highly Purified Urinary FSH versus Recombinant FSH in Chinese Women over 37 Years Undergoing Assisted Reproductive Techniques
متن کامل
P-75: Role of Anti-Mullerian Hormone in Prediction of Assisted Reproductive Technology Outcomes
Background: Anti-Mullerian hormone (AMH) has been suggested as a marker of ovarian reserve and predictor of ovarian response to controlled ovarian hyper stimulation. The aim of this study is to determine the role of AMH in prediction of success ART cycles in patients with normal FSH serum levels. Materials and Methods: This prospective cohort study included 80 infertile women under 4o years, wh...
متن کاملذخیره در منابع من
با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید
برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید
ثبت ناماگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید
ورودعنوان ژورنال:
- The Cochrane database of systematic reviews
دوره 2 شماره
صفحات -
تاریخ انتشار 2011