Effectiveness and safety of rLH and rFSH in patients undergoing in vitro fertilisation/intracytoplasmic sperm microinjection applied GnRH antagonist protocol: A meta-analysis / 解放军医学杂志

ABSTRACT

Objective To compare the effectiveness and safety of recombinant luteinizing hormone (rLH) combined with recombinant follicle-stimulating hormone (rFSH) and rFSH alone in women undergoing in vitro fertilisation/intracytoplasmic sperm microinjection (IVF/ICSI) applied gonadotrophin-releasing hormone (GnRH) antagonist. Methods The databases including PubMed, Embase, Cochrane Library, ClinicalTrials.gov, CNKI, VIP and Wanfang Data were electronically searched to collect the randomized controlled trials (RCT) applied GnRH antagonist using rLH+rFSH or rFSH alone in IVF/ISCI cycles from inception to Dec. 2018. Following the Cochrane system evaluation and according to the criteria for inclusion and exclusion, two reviewers independently screened literature, extracted data and evaluated the bias risk for inclusion in studies, and then meta-analysis was conducted by RevMan 5.3 software. Results A total of 10 RCT studies involving 1965 patients were included, of them 988 cases in rFSH+rLH group and 977 cases in rFSH alone group. Meta-analysis showed no significant difference between rFSH alone group and rLH+rFSH group in clinical pregnancy rate (RR=1.02, 95%CI 0.82-1.27, P=0.85), ongoing pregnancy rate (RR=1.06, 95%CI 0.86-1.32, P=0.57), miscarriage rate (RR=1.38, 95%CI 0.75-2.54, P=0.29), incidence of adverse events canceled due to ovarian hyporesponsiveness (RR=0.90, 95%CI 0.42-1.93, P=0.78), and the incidence of adverse events canceled due to ovarian hyperstimulation syndrome (OHSS) (RR=1.06, 95%CI 0.56-1.99, P=0.86). Conclusions Current evidence shows that, compared with rFSH alone group, the rLH+rFSH group showed no effect on the clinical pregnancy rate, ongoing pregnancy rate, miscarriage rate, incidence of adverse events canceled due to ovarian hyporesponsiveness, and the incidence of adverse events canceled due to OHSS. The above conclusions need to be verified by more high quality research since the quality and quantity limited of included studies.