Mild versus conventional ovarian stimulation for IVF in poor responders: a systematic review and meta-analysis

REPRODUCTIVE BIOMEDICINE ONLINE

卷:41

Review

Datta, Adrija Kumar¹  Maheshwari, Abha^2,3  Felix, Nirmal¹  Campbell, Stuart^4,5  Nargund, Geeta^4,6 

[1] CREATE Fertil, 6270 Bishops Court,Birmingham Business Pk, Birmingham B37 7YB, W Midlands, England

[2] NHS Grampian, Aberdeen Fertil, Foresterhill, Aberdeen AB25 2ZL, Scotland

[3] Univ Aberdeen, Aberdeen, Scotland

[4] CREATE Fertil, 150 Cheapside, London EC2V 6ET, England

[5] St Georges Univ London, London, England

[6] St Georges Univ Hosp NHS Trust, London, England

关键词: Conventional stimulation;    IVF;    Meta-analysis;    Mild ovarian stimulation;    Poor responders;    Systematic review;   

DOI  :  10.1016/j.rbmo.2020.03.005

来源: Elsevier

【 摘 要 】

Mild ovarian stimulation is a treatment option for poor responders in IVF treatment. Our updated review evaluated mild IVF solely from randomized controlled trials (RCTs) that used genuine low-dose gonadotrophin (<= 150 IU daily) alone or in combination with oral medications, comparing it with conventional-dose ( 150 IU/ daily) IVF for poor responders. Electronic searches on MEDLINE, Embase, The Cochrane Central Register of Controlled Trials and PreMEDLINE, and hand searches from 2002 up to 31 January 2019, identified 14 RCTs, which were compiled with the above inclusion criteria. The risk of bias (ROB) and quality of evidence (QOE) were assessed as per Cochrane Collaboration. Meta-analyses found no difference in live birth rate (four RCTs, n = 1057, RR 0.91, CI 0.66 to 1.25) (moderate QOE), ongoing pregnancy rate (six RCTs, n = 1782, RR 1.01, CI 0.86 to 1.20) (moderate-high QOE) and cycle cancellation rates (14 RCTs, n = 2746, RR 1.38, CI 0.99 to 1.92) (low QOE). Fewer oocytes and embryos were obtained from mild IVF; however, the number and proportion of high-grade embryos were similar. Mild IVF resulted in reduced gonadotrophin use and cost. The inference remained unchanged when smaller studies with ROB were excluded, or whether gonadotrophin alone or combination with oral medication was used. The evidence of equal efficacy from a pooled population, which was adequately powered for live birth, supported a mild IVF strategy for poor responders in preference to more expensive conventional IVF. Although clinical heterogeneity remained a limiting factor, it increased the generalizability of the findings.

【 授权许可】

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