Systematic Review and Meta-analysis on the Effect of Adjuvant Gonadotropin-releasing Hormone Agonist (GnRH-a) on Pregnancy Outcomes in Women with Endometriosis Following Conservative Surgery.

Systematic Review and Meta-analysis on the Effect of Adjuvant Gonadotropin-releasing Hormone Agonist (GnRH-a) on Pregnancy Outcomes in Women with Endometriosis Following Conservative Surgery. | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Systematic Review and Meta-analysis on the Effect of Adjuvant Gonadotropin-releasing Hormone Agonist (GnRH-a) on Pregnancy Outcomes in Women with Endometriosis Following Conservative Surgery. Xuemei Qing, Lele He, Ying Ma, Yong Zhang, Wenxin Zheng This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3352837/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 04 Apr, 2024 Read the published version in BMC Pregnancy and Childbirth → Version 1 posted 10 You are reading this latest preprint version Abstract Background Endometriosis frequently results in pain and infertility. While conservative surgery offers some relief, it often falls short of ensuring satisfactory pregnancy outcomes. Adjuvant GnRH-a is administered post-surgery to mitigate recurrence; however, its impact on pregnancy outcomes remains debated. This study endeavors to assess the efficacy of adjuvant GnRH-a in enhancing pregnancy outcomes post-conservative surgery in endometriosis patients. Methods Databases including PubMed, Embase, the Cochrane Library, Medline (Ovid), Web of Science, and Scopus were rigorously searched up to 02 August 2023, without linguistic constraints. Identified articles were screened using strict inclusion and exclusion criteria. Evaluated outcomes encompassed pregnancy rate, live birth rate, miscarriage rate, ectopic pregnancy rate, multiple pregnancy rate, time from surgery to pregnancy, recurrence rate, and adverse reaction rate. The Cochrane risk of bias tool and the Jadad score evaluated the included studies' quality. Subgroup and sensitivity analysis were implemented to analyze the pooled results. A meta-analysis model expressed results as standardized mean difference (SMD) and Risk ratio (RR). Results A total of 17 studies about 2485 patients were assimilated. Meta-analysis revealed that post-surgery, the GnRH-a cohort experienced a marginally elevated pregnancy rate (RR = 1.20, 95% CI = 1.02–1.41; P = 0.03) and a reduced mean time to conceive (RR = -1.17, 95% CI = -1.70- -0.64; P < 0.0001). Contrarily, other evaluated outcomes did not exhibit notable statistical differences. Conclusions Incorporating adjuvant GnRH-a following conservative surgery may be deemed beneficial for women with endometriosis, especially before Assisted Reproductive Technology (ART). Nonetheless, owing to pronounced heterogeneity, subsequent research is warranted to substantiate these potential advantages conclusively. Registration number: CRD42023448280. endometriosis. conservative surgery. GnRH-a pregnancy rate Full Text Additional Declarations No competing interests reported. Supplementary Files Additionalfile1Searchqueries.docx Additional file 1: Search queries. Additionalfile2Specificreasonsforexclusionsafterfulltextreview.xlsx Additional file 2: Specific reasons for exclusions after full-text review. Additionalfile3Qualityevaluations.xls Additional file 3: Quality evaluations. Additionalfile4Basiccharacteristicsofincludedstudies.xlsx Additional file 4: Basic characteristics of included studies. Additionalfile5Detailedsubgroupstatisticalanalyses.docx Additional file 5: Detailed subgroup statistical analyses. Cite Share Download PDF Status: Published Journal Publication published 04 Apr, 2024 Read the published version in BMC Pregnancy and Childbirth → Version 1 posted Editorial decision: Revision requested 18 Jan, 2024 Reviews received at journal 11 Dec, 2023 Reviewers agreed at journal 08 Nov, 2023 Reviews received at journal 03 Nov, 2023 Reviewers agreed at journal 25 Oct, 2023 Reviewers invited by journal 25 Oct, 2023 Editor assigned by journal 25 Oct, 2023 Editor invited by journal 01 Oct, 2023 Submission checks completed at journal 01 Oct, 2023 First submitted to journal 13 Sep, 2023 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3352837","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":237144756,"identity":"bc9d8e42-4453-4a4a-b08d-b88f29fb922c","order_by":0,"name":"Xuemei Qing","email":"","orcid":"","institution":"Southwest Medical University","correspondingAuthor":false,"prefix":"","firstName":"Xuemei","middleName":"","lastName":"Qing","suffix":""},{"id":237144757,"identity":"8d237f0e-f09a-414a-9d26-d02f21904a71","order_by":1,"name":"Lele He","email":"","orcid":"","institution":"Southwest Medical 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Surgery.","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"endometriosis. conservative surgery. GnRH-a, pregnancy rate","lastPublishedDoi":"10.21203/rs.3.rs-3352837/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3352837/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eEndometriosis frequently results in pain and infertility. While conservative surgery offers some relief, it often falls short of ensuring satisfactory pregnancy outcomes. Adjuvant GnRH-a is administered post-surgery to mitigate recurrence; however, its impact on pregnancy outcomes remains debated. This study endeavors to assess the efficacy of adjuvant GnRH-a in enhancing pregnancy outcomes post-conservative surgery in endometriosis patients.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eDatabases including PubMed, Embase, the Cochrane Library, Medline (Ovid), Web of Science, and Scopus were rigorously searched up to 02 August 2023, without linguistic constraints. Identified articles were screened using strict inclusion and exclusion criteria. Evaluated outcomes encompassed pregnancy rate, live birth rate, miscarriage rate, ectopic pregnancy rate, multiple pregnancy rate, time from surgery to pregnancy, recurrence rate, and adverse reaction rate. The Cochrane risk of bias tool and the Jadad score evaluated the included studies' quality. Subgroup and sensitivity analysis were implemented to analyze the pooled results. A meta-analysis model expressed results as standardized mean difference (SMD) and Risk ratio (RR).\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eA total of 17 studies about 2485 patients were assimilated. Meta-analysis revealed that post-surgery, the GnRH-a cohort experienced a marginally elevated pregnancy rate (RR\u0026thinsp;=\u0026thinsp;1.20, 95% CI\u0026thinsp;=\u0026thinsp;1.02\u0026ndash;1.41; P\u0026thinsp;=\u0026thinsp;0.03) and a reduced mean time to conceive (RR = -1.17, 95% CI = -1.70- -0.64; P\u0026thinsp;\u0026lt;\u0026thinsp;0.0001). Contrarily, other evaluated outcomes did not exhibit notable statistical differences.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eIncorporating adjuvant GnRH-a following conservative surgery may be deemed beneficial for women with endometriosis, especially before Assisted Reproductive Technology (ART). Nonetheless, owing to pronounced heterogeneity, subsequent research is warranted to substantiate these potential advantages conclusively.\u003c/p\u003e\u003ch2\u003eRegistration number:\u003c/h2\u003e \u003cp\u003eCRD42023448280.\u003c/p\u003e","manuscriptTitle":"Systematic Review and Meta-analysis on the Effect of Adjuvant Gonadotropin-releasing Hormone Agonist (GnRH-a) on Pregnancy Outcomes in Women with Endometriosis Following Conservative Surgery.","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-10-06 12:00:33","doi":"10.21203/rs.3.rs-3352837/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-01-18T12:43:38+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2023-12-11T09:57:19+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"8ee87bb9-8254-4634-9e1f-7d9b93f75cca_SNPRID","date":"2023-11-08T21:00:57+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2023-11-03T16:20:17+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"957dd673-43cc-4ea9-9f62-945130d39fa4","date":"2023-10-25T16:45:35+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2023-10-25T16:30:06+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2023-10-25T11:11:37+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2023-10-01T07:17:17+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2023-10-01T07:11:58+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pregnancy and Childbirth","date":"2023-09-13T16:28:57+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"532392ab-a1f3-4ba6-9402-68ae92c59612","owner":[],"postedDate":"October 6th, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-04-08T15:10:25+00:00","versionOfRecord":{"articleIdentity":"rs-3352837","link":"https://doi.org/10.1186/s12884-024-06430-1","journal":{"identity":"bmc-pregnancy-and-childbirth","isVorOnly":false,"title":"BMC Pregnancy and Childbirth"},"publishedOn":"2024-04-04 15:01:50","publishedOnDateReadable":"April 4th, 2024"},"versionCreatedAt":"2023-10-06 12:00:33","video":"","vorDoi":"10.1186/s12884-024-06430-1","vorDoiUrl":"https://doi.org/10.1186/s12884-024-06430-1","workflowStages":[]},"version":"v1","identity":"rs-3352837","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3352837","identity":"rs-3352837","version":["v1"]},"buildId":"0SHbDDIpRTBOrFPTvp6pu","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}