Objectives Progestin-primed ovarian stimulation (PPOS) is a new ovarian stimulation protocol that can block the luteinizing hormone (LH) surge through progesterone instead of traditional down regulating or gonadotropin-releasing hormone (GnRH) antagonist, and in order to achieve multi-follicle recruitment. This paper aims to investigate the effectiveness of PPOS and its suitability for infertile patients with different ovarian reserve functions. Methods We searched published randomized controlled trials (RCTs) about PPOS on Cochrane Library, PubMed, Embase, and Web of Science. The search period spanned from January 1, 2015 to November 16, 2020. The data were extracted, and the meta-analysis was performed on ovarian stimulation as well as embryological and clinical outcomes. The outcomes were pooled by a random effects model, and the risk of heterogeneity was evaluated. Subgroup analysis was performed for different ovarian reserve patients. Results The clinical pregnancy rates and live birth or ongoing pregnancy rates with the PPOS protocol were not different from those with the control group. In the diminished ovarian reserve (DOR) subgroup, the PPOS protocol had a lower rate of premature LH surge [RR = 0.03, 95% CI = 0.01 to 0.13, p < 0.001]. The PPOS protocol had a lower rate of ovarian hyperstimulation syndrome (OHSS) [RR = 0.52, 95% CI = 0.36 to 0.76, p < 0.001, I2 = 0.00%]. The secondary outcomes showed that the number of oocytes retrieved, MII oocytes, and viable embryos was higher than that of the control protocol in DOR patients [(MD = 0.33, 95% CI = 0.30 to 0.36, p < 0.001), (MD = 0.30, 95% CI = 0.27 to 0.33, p < 0.001), (MD = 0.21, 95% CI = 0.18 to 0.24, p < 0.001)] and normal ovarian reserve (NOR) patients [(MD = 1.41, 95% CI = 0.03 to 2.78, p < 0.001), (MD = 1.19, 95% CI = 0.04 to 2.35, p < 0.001), (MD = 1.01, 95% CI = 0.21 to 1.81, p = 0.01)]. Conclusion The findings suggest that PPOS is an effective ovarian stimulation protocol and is beneficial for patients with different ovarian reserve functions, which needs to be validated in more RCTs with larger samples.

中文翻译：

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辅助生殖技术患者的孕激素启动卵巢刺激方案：随机对照试验的荟萃分析。


目的 孕激素促卵巢刺激（PPOS）是一种新的卵巢刺激方案，通过黄体酮代替传统的下调或促性腺激素释放激素（GnRH）拮抗剂来阻断黄体生成素（LH）激增，从而实现多卵泡招聘。本文旨在探讨PPOS的有效性及其对不同卵巢储备功能的不孕患者的适用性。方法 我们检索了 Cochrane 图书馆、PubMed、Embase 和 Web of Science 上已发表的有关 PPOS 的随机对照试验 (RCT)。检索时间跨度为2015年1月1日至2020年11月16日。提取数据，并对卵巢刺激以及胚胎学和临床结果进行荟萃分析。通过随机效应模型汇总结果，并评估异质性风险。对不同卵巢储备患者进行亚组分析。结果 PPOS 方案的临床妊娠率、活产率或持续妊娠率与对照组没有差异。在卵巢储备功能减退 (DOR) 亚组中，PPOS 方案的 LH 过早激增发生率较低 [RR = 0.03，95% CI = 0.01 至 0.13，p < 0.001]。 PPOS 方案的卵巢过度刺激综合征 (OHSS) 发生率较低 [RR = 0.52，95% CI = 0.36 至 0.76，p < 0.001，I2 = 0.00%]。次要结果显示，DOR 患者中取出的卵母细胞、MII 卵母细胞和存活胚胎的数量高于对照方案 [(MD = 0.33，95% CI = 0.30 至 0.36，p < 0.001)，(MD = 0.30，95% CI = 0.27 至 0.33，p < 0.001)，(MD = 0.21，95% CI = 0.18 至 0.24，p < 0.001)] 和正常卵巢储备 (NOR) 患者 [(MD = 1.41， 95% CI = 0.03 至 2.78，p < 0。001），（MD = 1.19，95% CI = 0.04 至 2.35，p < 0.001），（MD = 1.01，95% CI = 0.21 至 1.81，p = 0.01）]。结论 PPOS是一种有效的卵巢刺激方案，对不同卵巢储备功能的患者有益，需要更多更大样本的随机对照试验进行验证。