Gynecol Obstet Invest. 2025 Aug 28:1-18. doi: 10.1159/000547119. Online ahead of print.
ABSTRACT
AIM: This study aimed to investigate the impact of various endometrial preparation protocols on pregnancy outcomes in women with polycystic ovarian syndrome (PCOS) undergoing frozen embryo transfer (FET).
METHOD: We conducted a comprehensive search of electronic databases, including PubMed, EMBASE, and the Cochrane Library, from their inception until February 2024 to identify relevant studies. The network meta-analysis (NMA) was performed using STATA 14.0 software.
RESULTS: Seventeen studies met the inclusion criteria, encompassing 16,082 FET cycles (four randomised controlled trials and thirteen observational studies). Women with PCOS undergoing FET using the gonadotropin-releasing hormone agonist (GnRH-a) + hormone replacement therapy (HRT) protocol demonstrated a higher clinical pregnancy rate (CPR) compared to those using HRT alone (OR 1.50, 95% CI 1.13-1.99). No significant differences were observed in the ongoing pregnancy rate (OPR) and ectopic pregnancy rate (EPR) among the four examined endometrial preparation protocols (human menopausal gonadotropin [HMG]/follicle-stimulating hormone [FSH], letrozole [LE], HRT, and GnRH-a + HRT). Regarding the miscarriage rate (MR), the LE ovulation induction protocol exhibited a lower MR than the HRT protocol (OR 0.59, 95% CI 0.46-0.74). The surface under the cumulative ranking curve (SUCRA) indicated that the GnRH-a + HRT protocol was the most effective for the CPR. In contrast, the LE ovulation induction protocol was the most effective for minimising the MR.
CONCLUSION: Our NMA suggests that the GnRH-a + HRT protocol results in a higher CPR compared to the HRT protocol in PCOS women undergoing FET, albeit with a higher risk of miscarriage. While offering comparable CPRs and OPRs to the GnRH-a + HRT protocol, the LE ovulation induction protocol presents a lower MR than the other endometrial preparation protocols.
PMID:40875743 | DOI:10.1159/000547119