title: Effectiveness of GnRH antagonist in the management of subfertile couples undergoing controlled ovarian stimulation and intrauterine insemination: a meta-analysis.
abstract: BACKGROUND
  Recent studies have indicated the use of gonadotropin-releasing hormone antagonists (GnRH-ant) as an adjuvant treatment to prevent premature luteinization (PL) and improve the clinical outcomes in patients undergoing controlled ovarian stimulation (COS) with intrauterine insemination (IUI). However, the results of these studies are conflicting.
  
  
  METHODS
  We conducted a systematic review and meta-analysis of randomized trials aiming to compare the clinical efficacy of GnRH-ant in COS/IUI cycles. Twelve studies were identified that met inclusion criteria and comprised 2,577 cycles assigned to COS/IUI combined GnRH-ant or COS/IUI alone.
  
  
  RESULTS
  Meta-analysis results suggested that GnRH-ant can significantly increase the clinical pregnancy rate (CPR) (OR = 1.42; 95% CI, 1.13-1.78) and decrease the PL rate (OR = 0.22, 95% CI, 0.16-0.30) in COS/IUI cycles. Subgroup analysis results suggested statistically significant improvement in the CPR in non-PCOS patients (OR = 1.54; 95% CI, 1.03-2.31) but not in the PCOS population (OR = 1.65; 95% CI, 0.93-2.94) and multiple mature follicle cycles (OR = 1.87; 95% CI, 0.27-12.66). There were no difference in the miscarriage and multiple pregnancy rates between the groups.
  
  
  CONCLUSIONS
  This meta-analysis suggested that GnRH-ant can reduce the incidence of PL and increase the CPR when used in COS/IUI cycles, and it was especially useful for non-PCOS patients. However, evidence to support its use in PCOS patients is still insufficient.
authors.affiliation: Division of Reproductive Medical Center, West China Second University Hospital of Sichuan University, Chengdu, Sichuan, China.
authors.forename: Shan
authors.initials: S
authors.lastname: Luo
authors.affiliation: Division of Reproductive Medical Center, West China Second University Hospital of Sichuan University, Chengdu, Sichuan, China.
authors.forename: Shangwei
authors.initials: S
authors.lastname: Li
authors.affiliation: Division of Reproductive Medical Center, West China Second University Hospital of Sichuan University, Chengdu, Sichuan, China.
authors.forename: Song
authors.initials: S
authors.lastname: Jin
authors.affiliation: Division of Reproductive Medical Center, West China Second University Hospital of Sichuan University, Chengdu, Sichuan, China.
authors.forename: Ya
authors.initials: Y
authors.lastname: Li
authors.affiliation: Division of Reproductive Medical Center, West China Second University Hospital of Sichuan University, Chengdu, Sichuan, China.
authors.forename: Yaoyao
authors.initials: Y
authors.lastname: Zhang
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D005307:Fertilization in Vitro / Q000379:methods; D007987:Gonadotropin-Releasing Hormone / Q000037:antagonists & inhibitors* / Q000378:metabolism; D006062:Gonadotropins / Q000378:metabolism; D006727:Hormone Antagonists / Q000627:therapeutic use*; D006801:Humans; D007246:Infertility / Q000188:drug therapy* / Q000378:metabolism; D007315:Insemination, Artificial / Q000379:methods; D034461:Luteinization / Q000187:drug effects; D008297:Male; D010062:Ovulation Induction / Q000379:methods; D011247:Pregnancy; D018873:Pregnancy Rate; D055815:Young Adult
chemical_list: D006062:Gonadotropins; D006727:Hormone Antagonists; D007987:Gonadotropin-Releasing Hormone