Gonadotropin-releasing hormone agonists versus antagonists for controlled ovarian hyperstimulation in oocyte donors: a systematic review and meta-analysis

ObjectiveTo compare GnRH agonists and antagonists in oocyte-donation IVF treatment cycles by a systematic review and meta-analysis of trials.DesignSystematic review and meta-analysis of randomized clinical trials (RCT). Systematic literature searches were conducted, and all randomized trials that compared GnRH agonists with antagonists in oocyte-donation IVF treatment cycles were included. Study selection, quality appraisal, and data extractions were performed independently and in duplicate.SettingTertiary fertility center.Patient(s)A total of 1,024 oocyte donors treated in eight RCTs.Intervention(s)Comparison of GnRH agonists versus antagonists in oocyte-donation IVF treatment.Main Outcome Measure(s)Ongoing pregnancy, oocytes retrieved, duration of stimulation, gonadotropin consumption, and ovarian hyperstimulation syndrome incidence (OHSS) per randomized oocyte donor.Result(s)Meta-analysis of these studies showed no significant difference in ongoing pregnancy rate between the GnRH agonists and antagonists (risk ratio [RR] 1.15, 95% confidence interval [CI] 0.97 to 1.36). The duration of stimulation was significantly lower with the GnRH antagonist protocol (weighed mean difference [WMD] −0.90 days, 95% CI −1.61 to −0.20). No significant differences were observed in the number of oocytes retrieved (WMD −0.60, 95% CI −2.26 to +1.07), gonadotropin consumption (WMD −264 IU, 95% CI −682 to +154), or OHSS incidence (RR 0.62, 95% CI 0.18 to 2.15).Conclusion(s)No significant differences were observed in ongoing pregnancy rate or the number of retrieved oocytes after donor stimulation with GnRH agonist or antagonist protocols.