Summary of findings for the main comparison. GnRH agonist compared with HCG for oocyte maturation triggering in antagonist‐assisted reproductive technology.
| GnRH agonist compared with HCG for oocyte maturation triggering in antagonist‐assisted reproductive technology | ||||||
| Population: subfertile women Settings: assisted reproductive technology: autologous cycles Intervention: GnRH agonist Comparison: HCG | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | Number of participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| HCG for oocyte maturation triggering | GnRH agonist | |||||
| Live birth | 313 per 1000 | 176 per 1000 (124 to 242) | OR 0.47 (0.31 to 0.70 ) | 532 (5 studies) | ⊕⊕⊕⊝ Moderatea,d | |
| OHSS (mild, moderate or severe): overall risk | 5 per 1000 | 1 per 1000 (0 to 2) | OR 0.15 (0.05 to 0.47 ) | 989 (8 studies) | ⊕⊕⊕⊝ Moderateb | |
| OHSS (moderate or severe): overall risk | 5 per 1000 | 1 per 1000 (0 to 3) | OR 0.21 (0.07 to 0.66 ) | 989 (8 studies) | ⊕⊕⊕⊝ Moderatec | Low event rate: 4 of 9 RCTs reported no events in either arm |
| OHSS (mild, moderate or severe) in women at high risk of OHSS | 308 per 1000 | 26 per 1000 (4 to 131) |
OR 0.06 (0.01 to 0.34) | 212 women (3 studies) |
⊕⊕⊕⊝ Moderateb | |
| Ongoing pregnancy | 256 per 1000 | 194 per 1000 (157 to 238) | OR 0.7 (0.54 to 0.91 ) | 1198 (11 studies) | ⊕⊕⊝⊝ Lowd,e | |
| Miscarriage | 67 per 1000 | 111 per 1000 (73 to 165) | OR 1.74 (1.10 to 2.75 ) | 1198 (11 studies) | ⊕⊕⊕⊝ Moderatee | |
| *The basis for the assumed risk is the median control group risk across studies. 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). CI: Confidence interval; OR: Odds ratio. | ||||||
| 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. | ||||||
aOne of the studies at high risk of bias because of premature termination.
bAll studies at high risk of bias in 1 or more domains. None clearly reported blinded outcome assessment.
cMost studies at high risk of bias in 1 or more domains. None clearly reported blinded outcome assessment.
dSubstantial heterogeneity: I2 = 59% to 66%.
e5/11 studies at high risk of bias because of early termination and/or inadequate allocation concealment. None clearly reported blinded outcome assessment.