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Meta-analysis of GnRH-antagonists versus GnRH-agonists in poor responder protocols

  • Gynecologic Endocrinology and Reproductive Medicine
  • Published:
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Abstract

Purpose

Considering the insufficient evidence supporting an ideal protocol for poor responder management in IVF/ICSI cycles, the aim of the current meta-analysis was to compare GnRH-antagonist versus GnRH-agonist protocols in poor responders, evaluating effectiveness and safety.

Methods

Meta-analysis was conducted using Medcalc 16.8 version software. Standardized mean differences (SMD), odds ratios (OR), and the respective 95% confidence intervals (CI) were determined appropriately. The Cochran Q statistic and the I2 test were used to assess studies’ heterogeneity.

Results

GnRH-agonists were shown to correlate with fewer cancelled IVF/ICSI cycles (p = 0.044, OR = 1.268 > 1, 95% CI 1.007, 1.598), a larger number of embryos transferred (p = 0.008, SMD = − 0.230, 95% CI − 0.400, − 0.0599), and more clinical pregnancies (p = 0.018, OR = 0.748 < 1, 95% CI 0.588, 0.952). However, GnRH-antagonists resulted in a significantly shorter duration of ovarian stimulation (p = 0.007, SMD = − 0.426. 95% CI − 0.736, − 0.115). The number of oocytes and mature oocytes retrieved in both protocols did not differ statistically (p = 0.216, SMD = − 0.130, 95% CI − 0.337, 0.0763 and p = 0.807, SMD = − 0.0203, 95% CI − 0.183, 0.142, respectively). Moreover, a high heterogeneity among studies was observed regarding duration of ovarian stimulation (I2 = 90.6%), number of oocytes (I2 = 82.83%)/mature oocytes retrieved (I2 = 70.39%), and embryos transferred (I2 = 72.83%).

Conclusions

Based on the present meta-analysis, agonist protocols could be suggested as a first choice approach, in terms of effectiveness. Due to the high studies’ heterogeneity, results should be considered with caution. Accordingly, larger cohort studies and meta-analyses like the present one will enhance the robustness of the emerging results to identify the ideal protocol for poor responders.

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Authors and Affiliations

  1. Molecular Biology Unit, Division of Human Reproduction, 1st Department of Obstetrics and Gynecology, ‘Alexandra’ General Hospital, National and Kapodistrian University of Athens, 80, Vasilissis Sofias Ave, 11528, Athens, Greece

    Myrto Papamentzelopoulou, Despoina Mavrogianni & Petros Drakakis

  2. 1st Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Athens, Greece

    Sofoklis Stavros, Christos Kalantzis, Dimitrios Loutradis & Petros Drakakis

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  1. Myrto Papamentzelopoulou
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  2. Sofoklis Stavros
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  3. Despoina Mavrogianni
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  4. Christos Kalantzis
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  6. Petros Drakakis
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Contributions

All authors contributed to the study conception and design. Data analysis and manuscript writing were performed by MP. Data collection was performed by SS, while in data collection and management CK was involved. DM edited the manuscript. DL was involved in the development of the project. PD was also involved in the development of the project and supervised it. All authors read and approved the final manuscript.

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Correspondence to Myrto Papamentzelopoulou.

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Papamentzelopoulou, M., Stavros, S., Mavrogianni, D. et al. Meta-analysis of GnRH-antagonists versus GnRH-agonists in poor responder protocols. Arch Gynecol Obstet 304, 547–557 (2021). https://doi.org/10.1007/s00404-020-05954-z

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