Table 2.
Summary of finding table.
| Outcome | Anticipated absolute effects (95% CI) | Relative effect (95% CI) | № of participants (studies) | Certainty | |
|---|---|---|---|---|---|
| Risk with Long GnRH agonist | Risk with Conventional GnRH antagonist | ||||
| Live birth rate | 486 per 1,000 | 379 per 1,000 (224 to 642) | RR 0.78 (0.46 to 1.32) | 74 (1 RCT) | ⨁⨁◯◯ LOW a |
| Ongoing pregnancy rate | 435 per 1,000 | 400 per 1,000 (339 to 470) | RR 0.92 (0.78 to 1.08) | 785 (5 RCTs) | ⨁⨁⨁⨁ HIGH |
| OHSS rate (All grades) | 173 per 1,000 | 101 per 1,000 (76 to 134) | RR 0.58 (0.44 to 0.77) | 994 (9 RCTs) | ⨁⨁◯◯ LOW b,c |
| Mild OHSS rate | 204 per 1,000 | 165 per 1,000 (98 to 279) | RR 0.81 (0.48 to 1.37) | 229 (3 RCTs) | ⨁◯◯◯ VERY LOW a,b |
| Moderate-Severe OHSS rate | 196 per 1,000 | 127 per 1,000 (102 to 161) | RR 0.65 (0.52 to 0.82) | 1114 (9 RCTs) | ⨁◯◯◯ VERY LOW b,d |
| Clinical pregnancy rate | 415 per 1,000 | 399 per 1,000 (320 to 494) | RR 0.96 (0.77 to 1.19) | 840 (8 RCTs) | ⨁⨁⨁⨁ HIGH |
| Multiple pregnancy rate | 99 per 1,000 | 86 per 1,000 (58 to 125) | RR 0.87 (0.59 to 1.27) | 994 (9 RCTs) | ⨁◯◯◯ VERY LOW b,d |
| Miscarriage rate | 86 per 1,000 | 80 per 1,000 (53 to 123) | RR 0.93 (0.61 to 1.43) | 997 (7 RCTs) | ⨁◯◯◯ VERY LOW a,b |
| Cycle cancellation rate | 54 per 1,000 | 62 per 1,000 (37 to 103) | RR 1.15 (0.69 to 1.91) | 1002 (8 RCTs) | ⨁◯◯◯ VERY LOW a,b |
| Cycle cancellation rate due to high risk of OHSS | 32 per 1,000 | 19 per 1,000 (8 to 43) | RR 0.59 (0.26 to 1.34) | 869 (6 RCTs) | ⨁◯◯◯ VERY LOW a,b |
| Cycle cancellation rate due to poor ovarian response | 7 per 1,000 | 32 per 1,000 (10 to 99) | RR 4.63 (1.49 to 14.41) | 869 (6 RCTs) | ⨁◯◯◯ VERY LOW b,e |
| Duration of stimulation | The mean duration of stimulation ranged from 9.07–13.92 Days | MD 0.91 Days. Lower (1.45 lower to 0.37 lower) | – | 1182 (10 RCTs) | ⨁◯◯◯ VERY LOW f,g |
| Gonadotropin Dose | The mean gonadotropin Dose ranged from 2675.5–1370.16 IUs | MD 221.36 IUs. Lower (332.28 lower to 110.45 lower) | – | 845 (7 RCTs) | ⨁⨁⨁⨁ HIGH |
| E2 levels hCG day | The mean E2 levels day of hCG ranged from 2232.7–4424.43 pg/ml | MD 259.21 pg/ml. lower (485.81 lower to 32.6 lower) | – | 995 (8 RCTs) | ⨁⨁⨁◯ MODERATE g |
| Endometrial thickness on hCG day | The mean endometrial thickness on day of hCG ranged from 6.7–11.57 mm | MD 0.73 mm. lower (1.17 lower to 0.29 lower) | – | 550 (5 RCTs) | ⨁⨁⨁◯ MODERATE g |
| Number of retrieved oocytes | The mean no. of retrieved oocytes ranged from 13.71–26.07 oocytes | MD 1.82 oocytes. Lower (3.48 lower to 0.15 lower) | – | 770 (8 RCTs) | ⨁⨁◯◯ LOW g,h |
E2: Estradiol, GnRH: Gonadotropin-releasing hormone, hCG: Human chorionic gonadotropin, OHSS: ovarian hyperstimulation syndrome.
aEvidence downgraded by two levels for very serious imprecision – 95% CI includes both appreciable benefit and harm or no effect and very low number of events (total number of events < 300).
bEvidence downgraded by one level for serious risk of bias – the majority of the RCTs have some concern or high risk of bias.
cEvidence downgraded by one level for serious imprecision – low number of events (total number of events < 300).
dEvidence downgraded by two levels for very serious imprecision – 95% CI includes both appreciable effect and little or no effect and very low number of events (total number of events < 300).
eEvidence downgraded by two levels for very serious imprecision—low number of events (total number of events < 300) and the effect estimate has a wide confidence interval.
fEvidence downgraded by two levels for very serious inconsistency (unexplained heterogeneity).
gEvidence downgraded by one level for serious imprecision – 95% CI includes both appreciable effect and little or no effect.
hEvidence downgraded by one level for serious inconsistency (unexplained heterogeneity).