Impact of progestin ovarian stimulation on newborn outcomes: a meta-analysis
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ASSISTED REPRODUCTION TECHNOLOGIES
Impact of progestin ovarian stimulation on newborn outcomes: a meta-analysis Irene Zolfaroli 1 & Gemma Arribas Ferriol 1 & Juan-José Hidalgo Mora 1 & Antonio Cano 1,2 Received: 3 December 2019 / Accepted: 17 March 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Objectives To compare progestin ovarian stimulation protocols with gonadotropin-releasing hormone analogue (agonists and antagonists) protocols on newborn outcomes. Methods The PubMed, Embase, Cochrane Central Register of Controlled Trials, and BioMed Central databases were searched for studies comparing progestin prime ovarian stimulation (PPOS) protocols with gonadotropin-releasing hormone analogues. Data were pooled by meta-analysis using a random effects model. Main outcome measures Primary endpoint was the risk of newborn congenital malformations. Results A total of 4 studies involving 9274 live-born infants were included. No important harm was observed with PPOS in terms of congenital malformations (OR 0.92; 95% CI 0.63–1.34; p = 0.65) (very low quality of evidence (QOE)) and low birth weight (OR 1.06; 95% CI 0.95–1.18; p = 0.29) (very low QOE) as compared with GnRH-a short protocols. In addition, a trend to a lower risk of preterm birth (OR 0.90; 95% CI 0.80–1.02; p = 0.10) (very low QOE) was found among patients treated with a PPOS protocol. Conclusions PPOS protocols, compared with GnRH-a protocols, are associated with a similar congenital malformation risk profile. Therefore, PPOS might represent a safe and appealing treatment option for infertile patients. Keywords Progesterone . Congenital malformations . In vitro fertilization . Progestin-primed ovarian stimulation
Introduction Assisted reproductive technologies (ART) have impressively evolved in the last few years in terms of number of cycles performed, number of newborns, and development of new strategies. The most widespread protocol variants for controlled ovarian hyperstimulation (COH) in ART are based on gonadotropinreleasing hormone agonists (GnRH-a) and antagonists. GnRH Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10815-020-01755-0) contains supplementary material, which is available to authorized users. * Irene Zolfaroli [email protected] 1
Department of Obstetrics and Gynecology, Hospital Clínico Universitario, Avenida Blasco Ibañez 17, 46010 Valencia, Spain
2
Department of Pediatrics, Obstetrics and Gynecology, University of Valencia, Valencia, Spain
analogues are used to block the luteinizing hormone (LH) surge associated with the increase of estrogens. Progestin prime ovarian stimulation (PPOS) became a reality in ART techniques when, in the latest 2000, the feasibility of COH during luteal phase stimulation was shown [1]. Investigators noticed that no spontaneous LH surge occurred during luteal phase stimulation. It was then postulated that endogenous progesterone could block the rise of this gonadotropic hormone [2]. Progesterone administration fro
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