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ART outcomes following ovarian stimulation in the luteal phase:a systematic review and meta-analysis

  • Assisted Reproduction Technologies
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Abstract

Purpose

This study aimed to evaluate the impact of luteal phase ovarian stimulation (LPS) on the outcomes of assisted reproductive technology (ART) for infertile couples and patients desiring non-urgent egg cryopreservation.

Methods

We included all studies reported patients who received LPS and that used follicular phase ovarian stimulation (FPS) as a comparison group until January 2021. Prior meta-analysis regarding the outcomes of LPS in double stimulation and fertility preservation have already been published, so these studies were excluded. Risk of Bias in Non-randomized Studies of Interventions was used to assess the study quality. The study was registered in the International Prospective Register of Systematic Reviews database (CRD42020183946).

Results

Twelve studies with a total of 4433 patients were included. The regimen employed can be categorized into two groups, but there is currently no evidence to support one over the other. After we excluded the largest study, the clinical pregnancy rate and live birth rate were similar after FPS and LPS. There were significantly more stimulation days and total gonadotropins used in the LPS group. After subgroup analysis, we found that poor responders received significantly more cumulus oocyte complexes (+0.64) in the LPS group.

Conclusion

Current evidence indicates that patients in the LPS group could achieve pregnancy outcomes non-inferior to those in the FPS group. Because of current debate over freeze-all policy and the limited data about live birth rate, the universal use of LPS is considered controversial. In the future, more well-designed studies are necessary to investigate the indications for LPS and its cost-effectiveness.

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Acknowledgements

We would like to express our gratitude for the help from Taipei Medical University, Division of Reproductive Medicine, Department of Obstetrics and Gynecology, Taipei Medical University Hospital, and Ministry of Science and Technology, Taiwan. Also, we would like to thank Online English for editing and proofreading this manuscript.

Funding

Ministry of Science and Technology, Taiwan (No. 106-2314-B-038-076, No. 107-2314-B-038-058, No. 108-2314-B-038-095) and Taipei Medical University (TMU109-F-002)

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Authors and Affiliations

  1. Division of Reproductive Medicine, Department of Obstetrics and Gynecology, Taipei Medical University Hospital, No.252, Wu Hsing Street, Taipei, 110, Taiwan

    Buo-Jia Lu & Chi-Huang Chen

  2. Department of Family Medicine, Hsinchu MacKay Memorial Hospital, No. 690, Section 2, Guangfu Road, East District, Hsinchu, 30071, Taiwan

    Chien-Ju Lin

  3. Department of Gastroenterology, Ren-Ai Branch, Taipei City Hospital, No. 10, Sec. 4, Ren-Ai Rd., Da’an Dist, Taipei, 106, Taiwan

    Bou-Zenn Lin

  4. Department of Family Medicine, Taipei Medical University Hospital, No.252, Wu Hsing Street, Taipei, 110, Taiwan

    Li Huang

  5. Taipei Medical University Library, No.250, Wu Hsing Street, Taipei, 110, Taiwan

    Li-Ting Chien

  6. Department of Obstetrics and Gynecology, School of Medicine, College of Medicine, Taipei Medical University, No.250, Wu Hsing Street, Taipei, Taiwan

    Chi-Huang Chen

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  1. Buo-Jia Lu
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Contributions

BJ Lu: chart collection, data analysis, manuscript writing.

CJ Lin: data analysis, manuscript writing.

BZ Lin: manuscript writing.

Li Huang: data analysis.

LT Chien: database searching.

CH Chen: data collection, manuscript editing.

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Correspondence to Chi-Huang Chen.

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Lu, BJ., Lin, CJ., Lin, BZ. et al. ART outcomes following ovarian stimulation in the luteal phase:a systematic review and meta-analysis. J Assist Reprod Genet 38, 1927–1938 (2021). https://doi.org/10.1007/s10815-021-02237-7

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