Pretreatment of Dienogest for Women with Endometriosis in in vitro Fertilization: A Systematic Review and Meta-Analysis

INTRODUCTION: Dienogest (DNG) was demonstrated to be comparable to gonadotropin-releasing hormone agonist (GnRH-a) in controlling symptoms of endometriosis. GnRH-a is used before in vitro fertilization (IVF) in women with endometriosis to improve pregnancy outcomes. We aimed to determine the effect of DNG pretreatment on IVF outcomes, including number of mature oocytes, rate of clinical pregnancies, and rate of live births in women with endometriosis. METHODS: All studies involving DNG, IVF, and endometriosis were searched from the PubMed; Ovid/MEDLINE, Wanfang, CQVIP, China National Knowledge Infrastructure databases; and ClinicalTrials.gov. The study population was women with endometriosis in IVF. Randomized controlled trials and cohort studies were included. All included studies comprised a DNG group and a control group. The outcomes were number of mature oocytes, rate of clinical pregnancies, and rate of live births. We calculated the odds ratio or mean difference and 95% confidence interval for each study and used a random-effects model to estimate the results. RESULTS: Five articles were screened by the search strategy. One article without a control group was excluded. Finally, four articles with 422 patients were included. No significant differences in number of mature oocytes (MD = -1.27, 95% CI: -3.63 to 1.09, I2 = 91%), the rate of clinical pregnancies (odds ratio = 1.07, 95% CI: 0.33-3.47, I2 = 84%), or the rate of live births (odds ratio = 1.09, 95% CI: 0.34-3.46, I2 = 84%) were found between the DNG group and the control group. CONCLUSION: Pretreatment with DNG for women with endometriosis who underwent IVF could not improve the number of mature oocytes, the rate of clinical pregnancies, or the rate of live births.