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.