Table III.
Summary of evidence.
| Poor responders | Normal responders | Hyper-responders | |
|---|---|---|---|
| Livebirth rates |
No difference ⊕⊕⊕⊖ RR 0.91 [0.68, 1.22] RCT= 5, n= 1248 ✓ I2 0% ✓ Narrow CI ✓ 2 large RCTs low RoB ✓ No RCT contradicted × 1 study with unclear RoB × Clinical heterogeneity |
No difference ⊕⊕⊕⊖ RR 0.88 [CI 0.69, 1.12] RCT= 3, n= 573, ✓ I2 0% ✓ Narrow CI ✓ ↓ Clinical heterogeneity ✓ No RCT contradicted × Studies with unclear RoB |
No difference ⊕⊕⊕⊖ RR 0.98 [CI 0.79, 1.22] RCT= 2, n= 931 ✓ I2 0% ✓ Narrow CI ✓ Only 1 unclear RoB ✓ No RCT contradicted × ↑ Clinical heterogeneity |
| OHSS rates | – |
↓ with MD-IVF ⊕⊕⊕⊖ RR 0.26 [CI 0.14, 0.49] RCT= 9, n= 1925 ✓ I2 0% ✓ Narrow CI ✓ Large effect size × Unclear RoB × Clinical heterogeneity |
↓ with MD-IVF ⊕⊕⊕⊖ RR 0.47 [CI 0.31, 0.72] RCT=2, n=931 ✓ I2 0% ✓ Narrow CI ✓ Large effect size ✓ Low RoB (1 unclear) × Clinical heterogeneity |
| Cycle cancellation rates |
No difference ⊕⊖⊖⊖ RR 1.33 [CI 0.96, 1.85] RCT= 15, n= 3459 × I2 64% × Wide CI × Most RCTs with RoB × Clinical heterogeneity |
↑ with MD-IVF ⊕⊖⊖⊖ RR 2.08 [CI 1.38, 3.14]* RCT= 12, n= 2654 × I2 48% × Wide CI × Small RCTs, unclear RoB × Clinical heterogeneity |
No difference ⊕⊕⊕⊖ RR 1.31 [CI 0.98, 1.77] RCT= 2, n= 1348 ✓ I2 0% ✓ 2 large RCTs low RoB × Moderately wide CI Clinical heterogeneity |
| Ongoing pregnancy rates |
No difference ⊕⊕⊕⊖ RR 1.02 [CI 0.81, 1.25] RCT= 7, n= 2006 ✓ I2 0% ✓ Narrow CI ✓ 3 large RCTs low RoB ✓ No RCT contradicted × Clinical heterogeneity |
No difference ⊕⊕⊕⊖ RR 1.10 [CI 0.88, 1.38] RCT= 7, n= 1026 ✓ I2 0% ✓ ↓ Clinical heterogeneity ✓ No RCT contradicted × Small studies with unclear RoB |
No difference ⊕⊕⊖⊖ RR 0.86 [CI 0.61, 1.23] RCT= 1, n= 521 ✓ Large RCT ✓ Low RoB × Based on just 1 RCT with two different protocols |
| Number of oocytes retrieved (mean) |
↓ with MD-IVF ⊕⊕⊖⊖ SMD -0.43 [CI -0.58, -0.28] RCT= 14, n= 2773, ✓ Large effect size, narrow CI × I2 67% × RCTs with RoB × Clinical heterogeneity |
↓ with MD-IVF ⊕⊖⊖⊖ SMD -1.34 [CI -1.94, -0.75] RCT= 13, n= 3499, × I2 98% × Wide CI × RCTs with unclear RoB, × Clinical heterogeneity |
No difference ⊕⊕⊖⊖ SMD -0.31 [CI -0.74, 0.13] RCT=2, n=931 ✓ Low RoB (1 unclear) × I2 91% × Wide CI × Clinical heterogeneity |
| Number of embryos created (Mean) |
↓ with MD-IVF ⊕⊕⊖⊖ SMD -0.39 [CI -0.59, -0.20] RCT= 9, n= 1559, ✓ Narrow CI ✓ 2 large RCTs with low RoB × I2 59% × 1 RCT with high RoB × Clinical heterogeneity |
No difference ⊕⊖⊖⊖ SMD -0.30 [-0.58, 0.08] RCT= 7, n= 1884, × I2 79% × Small studies with wide CI × Multiple unclear RoB × Clinical heterogeneity |
Data not available |
| Number of high-grade embryos (Mean) |
No difference ⊕⊕⊖⊖ MD -0.12 [-0.30, 0.05] RCT= 4, n= 723 ✓ I2 0% ✓ 2 large RCTs with low RoB × 1 small RCT with high RoB × Clinical heterogeneity |
No difference ⊕⊕⊖⊖ MD -0.18 [-0.49, 0.13] RCT= 6, n= 551, ✓ I2 0% × Only 3 small RCTs (wide CI) with unclear RoB × Clinical heterogeneity |
Data not available |
| Proportion of high-grade embryos |
No difference ⊕⊕⊖⊖ Meta-analysis not possible ✓ All 3 RCTs including 1 large one with low RoB reported no difference |
No difference ⊕⊕⊖⊖ RR 1.07 [0.93, 1.23] RCT= 3, n= 656 ✓ I2 0% ✓ No RCT contradicted × 3 small RCTs, unclear RoB |
No difference ⊕⊕⊖⊖ 46.7% vs 42.1% [p>0.05] RCT= 1, n= 412 ✓ Only 1 RCT but large with low RoB |
| Gonadotropin dose (mean) |
↓ with MS-IVF ⊕⊕⊖⊖ SMD -3.17 [-3.80 -2.54] RCT= 13, n= 2314 ✓ Large effect size ✓ No RCT contradicted ✓ 3 large RCTs low RoB × I2 96% × RCTs with unclear/ high RoB × Clinical heterogeneity |
↓ with MS-IVF ⊕⊕⊖⊖ SMD of -5.86 [CI -7.06, -4.66] RCT= 11, n= 2583 ✓ Large effect size ✓ No RCT contradicted × I2 99% × RCTs with unclear/ high RoB × Clinical heterogeneity |
↓ with MS-IVF ⊕⊕⊖⊖ SMD -394.00 [-481.20 -306.80] RCT= 1, n= 412 ✓ Only 1 RCT but large with low RoB |
⊕⊕⊕⊖, moderate quality of evidence; ⊕⊕⊖⊖, low quality of evidence; ⊕⊖⊖⊖, very low quality of evidence; RR, relative risk; MD, mean difference; SMD, standardised mean difference; RoB, risk of bias.