Recombinant versus urinary human chorionic gonadotrophin for final oocyte maturation triggering in IVF and ICSI cycles

Mohamed A Youssef; Ahmed M Abou‐Setta; Wai Sun Lam

doi:10.1002/14651858.CD003719.pub4

Scolaris Content Display Scolaris Content Display

Contenido relacionado

Ir a:

Revisiones y protocolos relacionados
Respuestas clínicas Cochrane
Guías
Temas

Revisiones y protocolos relacionados

Respuestas clínicas Cochrane

Topics

Temas

Figure 1

Study flow diagram.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Figure 2

Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Figure 3

Methodological quality summary: review authors' judgements about each methodological quality item for each included study.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Figure 4

Forest plot of comparison: 1 rhCG versus uhCG for triggering ovulation, outcome: 1.1 Ongoing pregnancy/live birth rate per woman.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Figure 5

Forest plot of comparison: 1 rhCG versus uhCG for triggering ovulation, outcome: 1.2 OHSS per woman.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Figure 6

Forest plot of comparison: 1 rhCG versus uhCG for triggering ovulation, outcome: 1.3 Clinical pregnancy rate per woman.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Figure 7

Forest plot of comparison: 1 rhCG versus uhCG for triggering ovulation, outcome: 1.4 Miscarriage rate per woman.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Figure 8

Forest plot of comparison: 2 rhLH versus uhCG for triggering ovulation, outcome: 2.1 Ongoing pregnancy/live birth rate per woman.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Figure 9

Forest plot of comparison: 2 rhLH versus uhCG for triggering ovulation, outcome: 2.2 OHSS per woman.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.1

Comparison 1 rhCG versus uhCG for triggering ovulation, Outcome 1 Ongoing pregnancy/live birth rate per woman.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.2

Comparison 1 rhCG versus uhCG for triggering ovulation, Outcome 2 OHSS per woman.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.3

Comparison 1 rhCG versus uhCG for triggering ovulation, Outcome 3 Clinical pregnancy rate per woman.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.4

Comparison 1 rhCG versus uhCG for triggering ovulation, Outcome 4 Miscarriage rate per woman.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.5

Comparison 1 rhCG versus uhCG for triggering ovulation, Outcome 5 No of oocytes retrieved per woman.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.6

Comparison 1 rhCG versus uhCG for triggering ovulation, Outcome 6 Adverse events per woman.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.1

Comparison 2 rhLH versus uhCG for triggering ovulation, Outcome 1 Ongoing pregnancy/live birth rate per woman.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.2

Comparison 2 rhLH versus uhCG for triggering ovulation, Outcome 2 OHSS per woman.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.3

Comparison 2 rhLH versus uhCG for triggering ovulation, Outcome 3 Clinical pregnancy rate per woman.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.4

Comparison 2 rhLH versus uhCG for triggering ovulation, Outcome 4 Miscarriage rate per woman.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.5

Comparison 2 rhLH versus uhCG for triggering ovulation, Outcome 5 No of oocytes retrieved per woman.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.6

Comparison 2 rhLH versus uhCG for triggering ovulation, Outcome 6 Adverse events per woman.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Summary of findings for the main comparison. RhCG compared to uhCG for final oocyte maturation triggering in IVF and ICSI cycles

RhCG compared to uhCG for final oocyte maturation triggering in IVF and ICSI cycles
Population: women undergoing final oocyte maturation triggering in IVF and ICSI cycles Setting: ART Intervention: recombinant hCG (rhCG) Comparison: urinary human chorionic gonadotrophin (uhCG)
Outcomes	*Illustrative comparative risks (95% CI)**		Relative effect (95% CI)	No of participants (studies)	Quality of the evidence (GRADE)	Comments
	Assumed risk	Corresponding risk
	UhCG	RhCG
Ongoing pregnancy/live birth rate per woman	367 per 1000	396 per 1000 (344 to 454)	OR 1.15 (0.89 to 1.49)	1136 (7 studies)	⊕⊕⊕⊝ Moderate^a	—
OHSS per woman ‐ moderate to severe OHSS	10 per 1000	17 per 1000 (11 to 84)	OR 1.76 (0.37 to 8.45)	417 (3 studies)	⊕⊕⊝⊝ Low^b,c	—
Clinical pregnancy rate per woman	330 per 1000	343 per 1000 (300 to 388)	OR 1.06 (0.87 to 1.29)	1806 (13 studies)	⊕⊕⊕⊝ Moderate^a	—
Miscarriage rate per woman	51 per 1000	37 per 1000 (21 to 63)	OR 0.72 (0.41 to 1.25)	1347 (9 studies)	⊕⊕⊝⊝ Low^a,b	—
Adverse events per woman	331 per 1000	179 per 1000 (112 to 406)	OR 0.52 (0.35 to 0.76)	561 (5 studies)	⊕⊕⊕⊝ Moderate^b	Adverse events included: injection site pain, reaction, inflammation, nausea, vomiting, abdominal pain
The basis for the assumed risk* (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). ART: assisted reproduction therapy; CI: confidence interval; hCG: human chorionic gonadotrophin; ICSI: intracytoplasmic sperm injection; IVF: in vitro fertilisation; OR: odds ratio; rhCG: recombinant hCG; uhCG: urinary hCG
GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate.
^aThe pooled effect included both the line of no effect and appreciable benefit or harm. ^bTotal number of events is less than 300. ^cThe pooled effect included both the line of no effect and appreciable benefit and harm.

Summary of findings for the main comparison. RhCG compared to uhCG for final oocyte maturation triggering in IVF and ICSI cycles

Ir a la tabla de la revisión

Summary of findings 2. RhLH compared to uhCG for final oocyte maturation triggering in IVF and ICSI cycles

RhLH compared to uhCG for final oocyte maturation triggering in IVF and ICSI cycles
Population: women undergoing final oocyte maturation triggering in IVF and ICSI cycles Setting: ART Intervention: rhLH (recombinant luteinising hormone) Comparison: urinary human chorionic gonadotrophin (uhCG)
Outcomes	*Illustrative comparative risks (95% CI)**		Relative effect (95% CI)	No of participants (studies)	Quality of the evidence (GRADE)
	Assumed risk	Corresponding risk
	UhCG	RhLH
Ongoing pregnancy/live birth rate per woman	371 per 1000	359 per 1000 (231 to 512)	OR 0.95 (0.51 to 1.78)	289 (2 studies)	⊕⊝⊝⊝ Very low^a,b,c
OHSS per woman ‐ Moderate OHSS	126 per 1000	107 per 1000 (55 to 197)	OR 0.83 (0.40 to 1.70)	289 (2 studies)	⊕⊝⊝⊝ Very low^a,b,c
Clinical pregnancy rate per woman	407 per 1000	392 per 1000 (270 to 530)	OR 0.94 (0.54 to 1.64)	289 (2 studies)	⊕⊝⊝⊝ Very low^a,b,c
Miscarriage rate per woman	36 per 1000	34 per 1000 (14 to 82)	OR 0.95 (0.38 to 2.40)	280 (2 studies)	⊕⊝⊝⊝ Very low^a,b,c
Adverse events per woman	1 study reported this outcome in this comparison; event numbers were similar in both groups.			259 (1 study)	—
The basis for the assumed risk* (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). ART: assisted reproduction therapy; CI: confidence interval; hCG: human chorionic gonadotrophin; ICSI: intracytoplasmic sperm injection; IVF: in vitro fertilisation; OR: odds ratio; rhLH: recombinant luteinising hormone; uhCG: urinary hCG.
GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate.
^aThe pooled effect included both the line of no effect and appreciable benefit or harm. ^bTotal number of events is less than 300. ^c1 of the 2 included studies did not provide information about methods of randomisation, allocation concealment or blinding.

Summary of findings 2. RhLH compared to uhCG for final oocyte maturation triggering in IVF and ICSI cycles

Ir a la tabla de la revisión

Comparison 1. rhCG versus uhCG for triggering ovulation

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Ongoing pregnancy/live birth rate per woman Show forest plot	7	1136	Odds Ratio (M‐H, Fixed, 95% CI)	1.15 [0.89, 1.49]

1.1 Long GnRH agonist protocol	6	1017	Odds Ratio (M‐H, Fixed, 95% CI)	1.06 [0.80, 1.39]
1.2 GnRH antagonist protocol	1	119	Odds Ratio (M‐H, Fixed, 95% CI)	2.17 [1.00, 4.68]
2 OHSS per woman Show forest plot	8		Odds Ratio (M‐H, Fixed, 95% CI)	Subtotals only

2.1 Moderate to severe OHSS	3	417	Odds Ratio (M‐H, Fixed, 95% CI)	1.76 [0.37, 8.45]
2.2 Moderate OHSS	1	243	Odds Ratio (M‐H, Fixed, 95% CI)	0.78 [0.27, 2.27]
2.3 Mild to moderate OHSS	2	320	Odds Ratio (M‐H, Fixed, 95% CI)	1.0 [0.42, 2.38]
2.4 Undefined OHSS	3	495	Odds Ratio (M‐H, Fixed, 95% CI)	1.18 [0.50, 2.78]
3 Clinical pregnancy rate per woman Show forest plot	13	1806	Odds Ratio (M‐H, Fixed, 95% CI)	1.06 [0.87, 1.29]

3.1 Long GnRH agonist protocol	12	1687	Odds Ratio (M‐H, Fixed, 95% CI)	1.01 [0.82, 1.24]
3.2 GnRH antagonist protocol	1	119	Odds Ratio (M‐H, Fixed, 95% CI)	1.97 [0.93, 4.18]
4 Miscarriage rate per woman Show forest plot	8	1196	Odds Ratio (M‐H, Fixed, 95% CI)	0.72 [0.41, 1.25]

4.1 Long GnRH agonist protocol	7	1077	Odds Ratio (M‐H, Fixed, 95% CI)	0.73 [0.41, 1.29]
4.2 GnRH antagonist protocol	1	119	Odds Ratio (M‐H, Fixed, 95% CI)	0.5 [0.04, 5.67]
5 No of oocytes retrieved per woman Show forest plot	12	1744	Mean Difference (IV, Fixed, 95% CI)	‐0.11 [‐0.70, 0.47]

5.1 Long GnRH agonist protocol	11	1625	Mean Difference (IV, Fixed, 95% CI)	‐0.14 [‐0.73, 0.45]
5.2 GnRH antagonist protocol	1	119	Mean Difference (IV, Fixed, 95% CI)	1.20 [‐3.14, 5.54]
6 Adverse events per woman Show forest plot	5	561	Odds Ratio (M‐H, Fixed, 95% CI)	0.52 [0.35, 0.76]

Comparison 1. rhCG versus uhCG for triggering ovulation

Ir a la tabla de la revisión

Comparison 2. rhLH versus uhCG for triggering ovulation

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Ongoing pregnancy/live birth rate per woman Show forest plot	2	289	Odds Ratio (M‐H, Fixed, 95% CI)	0.95 [0.51, 1.78]

2 OHSS per woman Show forest plot	2	289	Odds Ratio (M‐H, Fixed, 95% CI)	0.83 [0.40, 1.70]

2.1 Moderate OHSS	2	289	Odds Ratio (M‐H, Fixed, 95% CI)	0.83 [0.40, 1.70]
3 Clinical pregnancy rate per woman Show forest plot	2	289	Odds Ratio (M‐H, Fixed, 95% CI)	0.94 [0.54, 1.64]

4 Miscarriage rate per woman Show forest plot	2	289	Odds Ratio (M‐H, Fixed, 95% CI)	0.95 [0.38, 2.40]

5 No of oocytes retrieved per woman Show forest plot	2	103	Mean Difference (IV, Fixed, 95% CI)	‐1.33 [‐3.26, 0.60]

6 Adverse events per woman Show forest plot	1		Odds Ratio (M‐H, Fixed, 95% CI)	Subtotals only

Comparison 2. rhLH versus uhCG for triggering ovulation

Ir a la tabla de la revisión

The Cochrane Library

Scolaris Language Selector Scolaris Language Selector

Idioma de la Revisión Cochrane

Idioma de la web

Scolaris Content Language Banner Portlet Scolaris Content Language Banner Portlet