促性腺激素释放激素激动剂用于辅助生殖技术黄体支持的荟萃分析
Effect of luteal-phase gonadotropin-releasing hormone agonist administration on pregnancy outcome in IVF/ICSI cycles:a systematic review and Meta-analysis
摘要目的系统评价促性腺激素释放激素激动剂(GnRH-a)用于辅助生殖技术(ART)黄体支持后,对妊娠结局产生的影响。方法计算机检索PubMed数据库、EMBASE数据库、Cochrane图书馆、随机对照试验(RCT)注册中心[WHO国际临床试验注册平台(ICTRP)和ClinicalTrials.gov]、中国生物医学文献数据库(CBM)、中国知网(CNKI)数据库及万方医学数据库中发表于2015年11月之前的原创性研究论文;收集在体外受精(IVF)或卵母细胞胞质内单精子注射(ICSI)中,GnRH-a应用于黄体支持的RCT文献。根据Cochrane系统评价方法,由2位评价员根据纳入及排除标准独立进行文献筛选、资料提取和质量评价后,采用Stata 13.0软件对符合质量标准的RCT文献进行荟萃分析,分析GnRH-a用于ART黄体支持后对妊娠结局产生的影响。结果共纳入11项研究,3406例患者,3280个周期。以采用标准黄体支持方案的研究人群为对照组,在标准黄体支持方案基础上加入GnRH-a的研究人群为试验组。试验组与对照组比较,出生率或继续妊娠率(RR=1.29,95%CI为1.11~1.51)、临床妊娠率(RR=1.24,95%CI为1.08~1.43)、多胎率(RR=1.95,95%CI为1.21~3.14)均明显增加。结论目前的证据表明,无论采用激动剂方案或拮抗剂方案降调,在黄体支持中加入GnRH-a均可增加出生率或继续妊娠率、临床妊娠率、多胎率,可为ART过程中的黄体支持提供新的治疗方案。
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abstractsObjective To evaluate the potential efficacy and safety of gonadotropin-releasing hormone agonist(GnRH-a) administration in the luteal-phase on in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) cycles in assisted reproductive technology (ART). Methods The relevant papers published before November 2015 were electronically searched in PubMed, EMBASE, Cochrane Library, WHO ICTRP, ClinicalTrials.gov, CNKI, CBM and WanFang database to collect randomized controlled trial (RCT) involving GnRH-a administration in the luteal-phase on IVF/ICSI cycles in ART. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed methodological quality according to the Cochrane Handbook. Then, Meta-analysis was performed using Stata 13.0. Results A total of 3 406 patients, 3 280 IVF/ICSI cycles from 11 RCT were subjected to Meta-analysis. All cycles presented statistically significantly higher rates of live birth/ongoing pregnancy (RR=1.29, 95%CI: 1.11-1.51), clinical pregnancy (RR=1.24, 95%CI:1.08-1.43) and multiple pregnancy (RR=1.95, 95%CI:1.21-3.14) in patients who received luteal-phase GnRH-a administration compared with those who did not. Conclusions These findings demonstrate that the luteal-phase GnRH-a administration could increase birth/ongoing pregnancy rate, clinical pregnancy rate and multiple pregnancy rate in all cycles, so it may be an ideal choice for luteal phase support in patients undergoing IVF/ICSI therapy.
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