TY - JOUR
T1 - Ovarian stimulation in the luteal phase
T2 - systematic review and meta-analysis
AU - Boots, C. E.
AU - Meister, M.
AU - Cooper, A. R.
AU - Hardi, A.
AU - Jungheim, E. S.
N1 - Funding Information:
C.E.B. received support from the National Research Training Program in Reproductive Medicine sponsored by the National Institute of Health (T32 HD040135-13) and the Scientific Advisory Board of Vivere Health. E.S.J. received support from the Women's Reproductive Health Research (WRHR) Program sponsored by the National Institute of Health (K12 HD063086), the Institute of Clinical and Translational Sciences (ICTS) at Washington University (UL1 TR000448), the Barnes Jewish Hospital Foundation, and the March of Dimes. A.R.C also received funding from the WRHR and ICTS programs.
Funding Information:
C.E.B. received support from the National Research Training Program in Reproductive Medicine sponsored by the National Institute of Health (T32 HD040135-13) and the Scientific Advisory Board of Vivere Health. E.S.J. received support from the Women’s Reproductive Health Research (WRHR) Program sponsored by the National Institute of Health (K12 HD063086), the Institute of Clinical and Translational Sciences (ICTS) at Washington University (UL1 TR000448), the Barnes Jewish Hospital Foundation, and the March of Dimes. A.R.C also received funding from the WRHR and ICTS programs.
Publisher Copyright:
© 2016, Springer Science+Business Media New York.
PY - 2016/8/1
Y1 - 2016/8/1
N2 - Purpose: The purpose of this study was to evaluate whether outcomes are different if controlled ovarian stimulation (COS) is started in the luteal phase rather than the follicular phase. Methods: A systematic review and meta-analysis was performed. Sixteen studies were included in the qualitative analysis, and eight studies with a total of 338 women were included in the quantitative analysis. Results: Cycles initiated in the luteal phase were slightly longer (WMD 1.1 days, 95 % CI 0.39–1.9) and utilized more total gonadotropins (WMD 817 IU, 95 % CI 489–1144). However, no differences were noted in peak estradiol levels (WMD −411 pg/ml, 95 % CI −906–84.7) or in the total number of oocytes retrieved (WMD 0.52 oocytes, 95 % CI −0.74–1.7). There were slightly more mature oocytes retrieved in the luteal phase (WMD 0.77 oocytes, 95 % CI 0.21–1.3), and fertilization rates were significantly higher (WMD 10 %, 95 % CI 0.03–0.18). While only three studies reported pregnancy outcomes, no difference was noted in the FET pregnancy rates after COS in the luteal versus follicular phase (RR 0.95, 95 % CI 0.56–1.7). A post hoc power analysis revealed that a sample of this size was sufficient to detect a clinically meaningful difference of 2 oocytes retrieved with 93 % power. Conclusion: Although initiating COS in the luteal phase requires a longer stimulation and a higher dose of total gonadotropin, these differences are not clinically significant. Furthermore, COS initiated in the luteal phase does not compromise the quantity or quality of oocytes retrieved compared to outcomes of traditional stimulation in the follicular phase.
AB - Purpose: The purpose of this study was to evaluate whether outcomes are different if controlled ovarian stimulation (COS) is started in the luteal phase rather than the follicular phase. Methods: A systematic review and meta-analysis was performed. Sixteen studies were included in the qualitative analysis, and eight studies with a total of 338 women were included in the quantitative analysis. Results: Cycles initiated in the luteal phase were slightly longer (WMD 1.1 days, 95 % CI 0.39–1.9) and utilized more total gonadotropins (WMD 817 IU, 95 % CI 489–1144). However, no differences were noted in peak estradiol levels (WMD −411 pg/ml, 95 % CI −906–84.7) or in the total number of oocytes retrieved (WMD 0.52 oocytes, 95 % CI −0.74–1.7). There were slightly more mature oocytes retrieved in the luteal phase (WMD 0.77 oocytes, 95 % CI 0.21–1.3), and fertilization rates were significantly higher (WMD 10 %, 95 % CI 0.03–0.18). While only three studies reported pregnancy outcomes, no difference was noted in the FET pregnancy rates after COS in the luteal versus follicular phase (RR 0.95, 95 % CI 0.56–1.7). A post hoc power analysis revealed that a sample of this size was sufficient to detect a clinically meaningful difference of 2 oocytes retrieved with 93 % power. Conclusion: Although initiating COS in the luteal phase requires a longer stimulation and a higher dose of total gonadotropin, these differences are not clinically significant. Furthermore, COS initiated in the luteal phase does not compromise the quantity or quality of oocytes retrieved compared to outcomes of traditional stimulation in the follicular phase.
KW - Controlled ovarian stimulation
KW - Fertility preservation
KW - In vitro fertilization
KW - Luteal phase
KW - Oocyte cryopreservation
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U2 - 10.1007/s10815-016-0721-5
DO - 10.1007/s10815-016-0721-5
M3 - Article
C2 - 27146151
AN - SCOPUS:84965029334
VL - 33
SP - 971
EP - 980
JO - Journal of Assisted Reproduction and Genetics
JF - Journal of Assisted Reproduction and Genetics
SN - 1058-0468
IS - 8
ER -