Objective To assess the necessity and effectiveness of salpingectomy before IVF-ET for hydrosalpinx among Chinese infertile patients. Methods The relevant papers published from 2000 to December of 2010 in China were electronically searched in CBM, VIP and CNKI to collect randomized controlled trials (RCTs) involving Chinese hydrosalpinx women with or without salpingectomy before IVF-ET. The quality of the included trials was independently assessed by two reviewers, and the data were extracted and analyzed by RevMan 5.0 software. Results Nine RCTs involving 687 patients and 730 IVF-ET cycles were identified. The results of meta-analyses showed that: a) There were significant differences between the two groups in Gn dosage (WMD=1.23, 95%CI 0.17 to 2.30, P=0.02), fertilization rate (RR=1.07, 95%CI 1.02 to 1.13, P=0.006), cleavage rate (RR=1.05, 95%CI 1.00 to 1.09, P=0.03), clinical pregnancy rate (RR=1.92, 95%CI 1.41 to 2.61, Plt;0.000 1), and abortion rate (RR=0.34, 95%CI 0.13 to 0.86, P=0.002); and b) There were no significant differences between the two groups in days of Gn (WMD= –0.27, 95%CI –0.59 to 0.06, P=0.11), E2 in HCG day (WMD=59.15, 95%CI –9.61 to 127.91, P=0.09), number of eggs (WMD= –0.27, 95%CI –0.44 to 0.99, P=0.46), quality embryonic rate (RR=1.02, 95%CI 0.91 to 1.14, P=0.79), and ectopic pregnancy rate (RR=0.22, 95%CI 0.03 to 1.82, P=0.16). Conclusion The current evidence shows that salpingectomy before IVF-ET for hydrosalpinx Chinese hydrosalpinx patients is necessary and effective. For the low quality of methodology of the included studies, more reasonably-designed and double-blind RCTs with large sample are required to provide more high-quality proof.
ObjectivesTo systematically review the efficacy of adjuvant growth hormone (GH) in IVF protocols.MethodsCBM, WanFang Data, CNKI, VIP, PubMed, EMbase, Web of Science and The Cochrane Library databases were electronically searched to collect randomized controlled trials (RCTs) on the efficacy of adjuvant GH in IVF protocols from inception to October 2019. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, the meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 10 RCTs involving 691 infertile females were included. Results of meta-analysis demonstrated that adjuvant GH in IVF protocols could increase collected oocytes number (MD=1.58, 95%CI 1.29 to 1.87, P<0.000 01), MⅡ stage oocytes number (MD=2.26, 95%CI 1.77 to 2.74, P<0.000 01), implantation rate (RR=1.20, 95%CI 1.02 to 1.40, P=0.03), clinical pregnancy rate (RR=1.46, 95%CI 1.08 to 1.98, P=0.01) and live birth rate (RR=1.62, 95%CI 1.05 to 2.51, P=0.03). However, there was no difference in fertilization rate (RR=1.06, 95%CI 0.97 to 1.16, P<0.18), miscarriage rate (RR=1.44, 95%CI 0.65 to 3.17, P=0.37) and adverse reactions between two groups.ConclusionsCurrent evidence shows that GH can improve the fertility outcomes of IVF cycles in patients with POR, elderly or previous IVF failures. But due to limited quality and quantity of the included studies, more high-quality studies are required to verify the above conclusion.
Objective To analyze published literature about the clinical studies on elective single versus double embryo transfer using meta-analysis, so as to provide more convincing evidence for the clinical application of elective single embryo transfer. Methods We electronically searched foreign and domestic biomedical databases including PubMed, Ovid, EMbase, MEDLINE and CENTRAL, to collect randomized controlled trials (RCTs) on elective single versus double embryo transfer. According to Cochrane systematic review method, two reviewers independently screened studies according to inclusion and exclusion criteria, extracted data, and assessed methodological quality of the included studies. Then, meta-analysis was performed using RevMan 5.1 software. Results A total of 9 RCTs involving 2 784 cases were included, of which, 1 452 were in the trial group while the other 1 332 were in the control group. The results of meta-analysis indicated that, compared with elective double embryo transfer, during each transfer period elective single embryo transfer reduced the live birth rate (RR=0.66, 95%CI 0.59 to 0.73, Plt;0.000 01), multiple pregnancy rate (RR=0.05 95%CI 0.02 to 0.11, Plt;0.000 01), preterm birth rate (RR=0.39, 95%CI 0.26 to 0.60, Plt;0.000 1), and low birth weight rate (RR=0.25, 95%CI 0.15 to 0.44, Plt;0.000 01). However, it had no effect on the ectopic pregnancy rate (RR=0.55, 95%CI 0.11 to 2.77, P=0.47), miscarriage rate (RR=1.33, 95%CI 0.92 to 1.91, P=0.13), and neonatal mortality rate (RR=0.31, 95%CI 0.03 to 2.76, P=0.29). Conclusion Compared with elective double embryo transfer, during each transfer period elective single embryo transfer reduces the live birth rate, multiple pregnancy rate, preterm birth rate, and low birth weight rate. No significant difference was found between the two groups in the other indicators.
Objective To systematically review the effectiveness of letrozole combined with GnRH antagonist for in vitro fertilization-embryo transfer (IVF-ET) in poor responders. Methods Such databases as VIP, CNKI, PubMed, EMbase and FMJS were electronically searched for randomized controlled trials (RCTs) or quasi-RCTs on the effectiveness of letrozole combined with GnRH antagonist for IVF-ET. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed methodological quality. Then, meta-analysis was performed using RevMan 5.0 software. Results Six studies involving 977 patients were finally included. The results of meta-analysis showed that, for IVF-ET poor responders, compared with the control group, the letrozole combined with GnRH antagonist group had less dosage of Gn (MD=–8.05, 95%CI –13.67 to –2.43, P=0.005), and lower serum E2 value on the day of HCG administration (MD= –1 026.41, 95%CI –1 949.61 to –103.20, P=0.03). However, no significant difference was found in the number of ocytes obtained (MD= –0.61, 95%CI –2.41 to –1.19, P=0.51) and clinical pregnancy rates (OR=1.03, 95%CI 0.53 to 2.02, P=0.92) between the two groups. Conclusion As for the effectiveness of impelling-ovulation treatment for IVF-ET in poor responders, letrozole combined with GnRH antagonist is similar to the control scheme in clinical outcomes, but it reduces the dosage of Gn and treatment costs of IVF-ET, which provides another clinical option for poor responders. Due to the limited quantity and quality of the included studies as well as the difference in methodology, we suggest this above conclusion could be taken as a reference for clinical analysis which needs to be further evaluated in its effects.
Objective To evaluate the effectiveness of GnRH antagonist in vitro fertilization-embryo transfer (IVF-ET) in polycystic ovary syndrome (PCOS) patients.Methods Such databases as PubMed (1997 to 2010), PML (1997 to 2010), FMJS (2000 to 2010), CBMdisc (1979 to 2010), CNKI (1994 to 2010), VIP (1989 to 2010), WanFang (1994 to 2010), and duxiu scholar searcher (www.duxiu.com), and nine relevant Chinese journals were searched for retrieving the randomized controlled trails (RCTs) on the effectiveness of GnRH antagonist versus GnRH agonist for IVF-ET in PCOS Patients. The studies were screened according to the inclusive and exclusive criteria by two reviewers independently, the data was abstracted and the quality was evaluated. The RevMan 4.2.7 software was used for Meta-analyses. Results Six grade-B studies involving 699 participants were included. The results of Meta-analyses showed that, compared with the GnRH agonist, there was no significant difference in the GnRH antagonist group about the stimulation duration (WMD= –1.23, 95%CI –2.76 to –0.31), dose of gonadotrophins (Gns) (WMD= –4.87, 95%CI –14.20 to 4.46), serum E2 value on the day of HCG administration (WMD= 31.37, 95%CI –263.40 to 326), number of oocytes retrieved (WMD= 1.34, 95%CI –1.02 to 4.70), clinical pregnancy rate (OR= 1.27, 95%CI 0.77 to2.10), and miscarraige rate (Peto OR= 0.67, 95%CI 0.38 to1.18). But the OHSS rate in the GnRH antagonist group was lower with a significant difference (Peto OR= 0.35, 95%CI 0.24 to 0.50). Conclusions Compared with the GnRH agonist protocol, the GnRH antagonist protocol can obviously reduce the incidence of OHSS, but has the same effect in Gn dose, retrieving oocytes and clinical pregnancy rate. Because the GnRH antagonist can decrease the treatment duration and cost, and has better safety, so it may be an ideal choice for PCOS patients to have IVF-ET therapy. For the quality and quantity limitation, and the methodology difference of the included studies, it is suggested that the conclusion from this study should be only served as a reference of clinical analyses, and should be revaluated and updated unceasingly.
【摘要】 目的 探讨各种不同体外受精（IVF）助孕方案对子宫腺肌病伴不孕症患者的疗效。 方法 对2006年1月-2009年6月进行IVF助孕治疗的子宫腺肌病伴不孕症患者63例的临床资料进行回顾性分析。根据是否应用长效促性腺激素释放激素激动剂（GnRH-a）及启动促性腺激素（Gn）时间分为超长方案、长效GnRH-a后长或短方案、常规长方案3组，对IVF助孕疗效进行分析。 结果 3种治疗方案的Gn刺激天数、Gn总量、获卵数、不良反应发生率和流产率比较无统计学意义（Pgt;0.05）；3种治疗方案的周期取消率为20.0%、7.7%、30.0%，比较有统计学意义（χ2=5.74，Plt;0.05），方案2的周期取消率低于方案1和方案3，有统计学意义（χ2=7.21，Plt;0.05）；3种治疗方案的继续妊娠率为23.0%、37.0%、15.3%，有统计学意义（χ2=11.31，Plt;0.05），方案2的继续妊娠率高于方案1和方案3，有统计学意义（χ2=8.52，Plt;0.05）。 结论 与超长方案和常规长方案相比，子宫腺肌病伴不孕症患者采用长效GnRH-a治疗后长方案或短方案行IVF助孕治疗，妊娠率升高，周期取消率降低。【Abstract】 Objective To investigate the effect of different in vitro fertilization (IVF) treatment protocols on infertile women with adenomyosis. Methods Sixty-four infertile women with adenomyosis who had IVF treatment cycles from January 2006 to June 2009 were retrospectively analyzed. According to administration of long course gonadotropin-releasing hormone agonist (GnRH-a) and the start time of gonadotropin (Gn), all participants were divided into three groups: the first group with ultra-long term protocol, the second group with long or short term protocol after administration of long course GnRH-a and the third group with routine long term protocol. Results There were no differences among the three groups with regard to days of Gn administration, amounts of Gn administration, numbers of retrieved oocytes, prevalence of poor response and miscarriage (Pgt;0.05). The cancelation rates of the three groups were 20.0%、7.7% and 30.0% respectively. There were significant differences in cancelation rates among the groups (χ2=5.74, Plt;0.05), and the cancelation rate in the second group was significantly lower than the other groups (χ2=7.21, Plt;0.05). The ongoing pregnancy rates of the groups were 23.0%、37.0% and 15.3% respectively. There were significant differences in ongoing pregnancy rates among three groups (χ2=11.31, Plt;0.05), and the ongoing pregnancy rate in the second group was significantly higher than the other groups (χ2=8.52, Plt;0.05). Conclusion Compared with the ultra-long term and routine long term protocol of IVF treatment in infertile woman with adenomyosis, the ongoing pregnancy rate might be higher and the cancelation rate might be lower in the long or short term protocol after administration of long course GnRH-a.
ObjectivesTo systematically review the efficacy and safety of local endometrial mechanical stimulation in patients with recurrent embryo implantation failure in vitro fertilization.MethodsPubMed, EMbase, The Cochrane Library, CNKI, WanFang Data and VIP databases were electronically searched to collect clinical controlled studies on the efficacy and safety of local endometrial mechanical stimulation in patients with recurrent embryo implantation failure from inception to March 2018. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 10 studies, including 8 randomized controlled trials and 2 case-control studies, and involving 1 274 patients were included. The results of meta-analysis showed that: the clinical pregnancy rate of endometrial mechanical stimulation group was higher than that of control group (RR=1.40, 95%CI 1.04 to 1.89, P=0.03). However, no significant differences were found in implantation rate (RR=0.75, 95%CI 0.50 to 1.13, P=0.17), live births rate (RR=1.38, 95%CI 0.99 to 1.93, P=0.06), miscarriage rate (RR=0.83, 95%CI 0.55 to 1.24, P=0.36) and rate of multiple pregnancy (RR=0.90, 95%CI 0.61 to 1.35, P=0.63).ConclusionCurrent evidence shows that, for patients with repeated implantation failure, mechanical endometrial stimulation before re-transplantation may help to improve the clinical pregnancy rate of test-tube infants, however, it has no significant effects on implantation rate, live birth rate, abortion rate, multiple pregnancy rate and ectopic pregnancy rate. Due to limited quality and quantity of the included studies, more high quality studies are needed required to verify above conclusions.
Objective To systematically review the endometrial receptivity evaluated by transvaginal ultrasound and predict the clinical pregnancy outcome of in vitro fertilization-embryo transfer (IVF-ET). Methods PubMed, The Cochrane Library, EMbase, Web of Science, CNKI, WanFang Data and VIP databases were electronically searched to collect studies on transvaginal ultrasound evaluation of endometrial receptivity to predict the clinical pregnancy outcome of IVF-ET from inception to December 1st, 2021. Two researchers independently screened literature, extracted data and evaluated the risk of bias of the included studies. RevMan 5.4 software and Stata 16.0 software were used to perform meta-analysis. Results A total of 24 cohort studies and 1 case-control study were included. The total sample size was 6 632 cases, including 3 340 in non-pregnancy group and 3 292 in pregnancy group. The results of meta-analysis showed that there was no difference in endometrial volume (MD=−0.11, 95%CI −0.33 to 0.11, P=0.34) or uterine artery S/D (MD= −0.04, 95%CI −0.17 to 0.09, P=0.55) between the two groups. The endometrial thickness measured on human chorionic gonadotrophin (HCG) day in the non-pregnant group (MD=−0.48, 95%CI −0.77 to −0.18, P=0.001) was thinner than that in the pregnant group. On embryo transfer (ET) day, uterine artery pulsatility index (PI) (MD=0.08, 95%CI 0.02 to 0.15, P=0.01) and resistance index (RI) (MD=0.01, 95%CI 0.01 to 0.01, P<0.000 01) were higher than those in the pregnancy group. Conclusion Endometrial volume and uterine artery S/D measured during IVF-ET were not correlated with clinical pregnancy outcome, while endometrial thickness measured on HCG day and uterine artery PI and RI measured on ET day were correlated with clinical pregnancy outcome. Transvaginal ultrasound evaluation of endometrial receptivity has a certain predictive value for clinical pregnancy outcome of IVF-ET. Due to the limited quality and quantity of included studies, more high-quality studies are needed to verify the above conclusion.