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Introducing Prospective
to the
Medical Literature
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Meta-analysis is a statistical
analysis which combines or
integrates the results of several
independent clinical trials
considered by the analyst to be
'combinable (Huque MF,1988 ).
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Meta-analysis can help
gynecologists keep abreast of
the medical literature by
summarising large bodies of
evidence and helping to
explain differences among
studies on the same topic
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A prospective meta-analysis is a
meta-analysis where studies
(usually RCTs) are identified,
evaluated and determined to be
eligible before the results of any of
the studies become known.
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PMA can therefore help to
overcome some of the problems of
retrospective meta-analyses by
enabling:
hypotheses to be specified a priori
ignorant of the results of
individual trials
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Prospective application of selection
criteria
A priori statements of intended
analyses, including sub-group
analyses, to be made before the
Results of individual trials are
known.
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GnRH antagonists have emerged
as another alternative in ART.
They are claimed to result in an
immediate arrest of
gonadotrophin secretion and so
the duration of treatment can be
reduced as well as the number of
ampoules of hMG.
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We wished to determine the role
of GnRH antagonists in
controlled ovarian
hyperstimulation.
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Infertile couple under assisted
reproductive program using
GnRH antagonists in the
protocol of ovulation induction.
The following characteristics of
the participants will be
considered.
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1. Infertile couple (explained and
unexplained infertility)
2. Have achieved ovarian
hyperstimulation (confirmed by
number of follicles seen by
ultrasound or estradiol assay)
3. Had controlled ovarian
hyperstimulation for any
assisted reproductive technique
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Primary outcomes:-
Number of oocyte retrieved per
cycle
Success rate (pregnancy /woman
, pregnancy/cycle) as determined
by serum B-HCG and ultrasound
examination for fetal heart.
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Secondary outcomes
Incidence of ovarian
hyperstimulation syndrome
Number of cycle cancellation
Cost benefit
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Meta-analysis of all randomised
controlled trials that will report
the use of Gonadotrophin
releasing hormone (GnRH)
antagonists verses GnRH
agonists in assisted
reproduction.
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1-The Cochrane MDSG
specialised register of controlled
trials
2-MEDLINE database
3-EMBASE database
4-Handsearching the references
mentioned in the obtained
studies and reviews.
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Method of ovarian
hyperstimulation.
Method of GnRH antagonists and
agonists administration: timing,
route, duration and dose
Number of ampoules of
gonadotrophin
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Data will be independently
extracted by the two reviewers
and any discrepancies will be
resolved by discussion. When
needed the reviewers will write
to the authors and the
pharmaceutical companies and
try to get hold of extra
information and the raw data.
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Heterogeneity between the
results of different studies will
be examined by inspecting the
scatter in the data points and the
overlap in their confidence
intervals and more formally by
checking results of chi-square
tests. Where possible the
outcomes will be pooled
statistically.
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The dichotomous data results for
each study will be expressed as
an odds ratio with 95%
confidence intervals. These
results will be combined for
meta-analysis with RevMan
software (using the Peto-
modified Mantel-Haenszel
method).
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GnRH antagonists meta-analysis can be
considered the first prospective meta-
analysis not only in the field of
reproductive medicine but in the entire
field of gynecology
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The results of this
systematic review will be
published in the
Cochrane Library soon.