Gonadotrophin-releasing hormone-antagonists vs long agonist in in-vitro fertilization patients with polycystic ovary syndrome: a meta-analysis.
OBJECTIVE
This article is a systematic review of the literature to establish whether there is an advantage in the use of GnRH antagonists (Ant) compared to the long agonist protocol (Ago) in patients with polycystic ovarian syndrome (PCOS).


METHODS
The meta-analysis was conducted using the MIX software with Mantel?Haenszel weighting method and the fixed effect model.


RESULTS
Five studies were identified. We analyzed 269 Ant and 303 Ago cycles. Pregnancy rates and the incidence of ovarian hyperstimulation syndrome (OHSS) were analyzed in all five studies, abortion rates were analyzed on three. Pregnancy rates did not differ between the groups: 137/269 (Ant Group) versus 172/303 (Ago Group) (OR: 0.80 CI: [0.57-1.11]). The incidence of OHSS per Ant (13/269) was significantly lower compared to the Ago (35/303) (OR: 0.47 CI: [0.24-0.92]). No difference was found between the two groups in the abortion rate: 10/77 (Ant Group) versus 9/88 (Ago Group) (OR: 1.29 CI: [0.49-3.36]).


CONCLUSIONS
The limited evidence present in literature suggests that in patients with PCOS there is no difference between a long Ago and an Ant protocol in terms of pregnancy and abortion rates. It seems more likely that the use of the Ant may reduce the incidence of OHSS.
Department of Obstetrics, Reproductive Medicine Service, Gynaecology and Reproductive Medicine, Institut Universitari Dexeus, Barcelona, Spain. fulman@dexeus.com
Fulvia
F
Mancini
Rosa
R
Tur
Francisca
F
Martinez
Buenaventura
B
Coroleu
Ignacio
I
Rodríguez
Pedro N
PN
Barri
D005260:Female; D005307:Fertilization in Vitro / Q000379:methods*; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists* / Q000037:antagonists & inhibitors*; D006801:Humans; D016471:Ovarian Hyperstimulation Syndrome / Q000517:prevention & control; D011085:Polycystic Ovary Syndrome / Q000503:physiopathology*; D011247:Pregnancy; D018873:Pregnancy Rate
D007987:Gonadotropin-Releasing Hormone