PDF(Pubmed)
Abstract：
BACKGROUND: Assisted reproductive technology (ART) has brought good news to infertile patients, but how to improve the pregnancy outcome of poor ovarian response (POR) patients is still a serious challenge and the scientific evidence of some adjuvant therapies remains controversial.
OBJECTIVE: Based on previous evidence, the purpose of this systematic review and network meta-analysis was to evaluate the effects of DHEA, CoQ10, GH and TEAS on pregnancy outcomes in POR patients undergoing in vitro fertilization and embryo transplantation (IVF-ET). In addition, we aimed to determine the current optimal adjuvant treatment strategies for POR.
METHODS: PubMed, Embase, The Cochrane Library and four databases in China (CNKI, Wanfang, VIP, SinoMed) were systematically searched up to July 30, 2022, with no restrictions on language. We included randomized controlled trials (RCTs) of adjuvant treatment strategies (DHEA, CoQ10, GH and TEAS) before IVF-ET to improve pregnancy outcomes in POR patients, while the control group received a controlled ovarian stimulation (COS) regimen only. This study was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The surface under the cumulative ranking curve (SUCRA) was used to provide a pooled measure of cumulative ranking for each outcome.
RESULTS: Sixteen RCTs (2323 women) with POR defined using the Bologna criteria were included in the network meta-analysis. Compared with the control group, CoQ10 (OR 2.22, 95% CI: 1.05 to 4.71) and DHEA (OR 1.92, 95% CI: 1.16 to 3.16) had obvious advantages in improving the clinical pregnancy rate. CoQ10 was the best in improving the live birth rate (OR 2.36, 95% CI: 1.07 to 5.38). DHEA increased the embryo implantation rate (OR 2.80, 95%CI: 1.41 to 5.57) and the high-quality embryo rate (OR 2.01, 95% CI: 1.07 to 3.78) and number of oocytes retrieved (WMD 1.63, 95% CI: 0.34 to 2.92) showed a greater advantage, with GH in second place. Several adjuvant treatment strategies had no significant effect on reducing the cycle canceling rate compared with the control group. TEAS was the least effective of the four adjuvant treatments in most pooled results, but the overall effect appeared to be better than that of the control group.
CONCLUSIONS: Compared with COS regimen, the adjuvant use of CoQ10, DHEA and GH before IVF may have a better clinical effect on the pregnancy outcome of POR patients. TEAS needs careful consideration in improving the clinical pregnancy rate. Future large-scale RCTs with direct comparisons are needed to validate or update this conclusion.
BACKGROUND: PROSPERO CRD42022304723.
OBJECTIVE: Based on previous evidence, the purpose of this systematic review and network meta-analysis was to evaluate the effects of DHEA, CoQ10, GH and TEAS on pregnancy outcomes in POR patients undergoing in vitro fertilization and embryo transplantation (IVF-ET). In addition, we aimed to determine the current optimal adjuvant treatment strategies for POR.
METHODS: PubMed, Embase, The Cochrane Library and four databases in China (CNKI, Wanfang, VIP, SinoMed) were systematically searched up to July 30, 2022, with no restrictions on language. We included randomized controlled trials (RCTs) of adjuvant treatment strategies (DHEA, CoQ10, GH and TEAS) before IVF-ET to improve pregnancy outcomes in POR patients, while the control group received a controlled ovarian stimulation (COS) regimen only. This study was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The surface under the cumulative ranking curve (SUCRA) was used to provide a pooled measure of cumulative ranking for each outcome.
RESULTS: Sixteen RCTs (2323 women) with POR defined using the Bologna criteria were included in the network meta-analysis. Compared with the control group, CoQ10 (OR 2.22, 95% CI: 1.05 to 4.71) and DHEA (OR 1.92, 95% CI: 1.16 to 3.16) had obvious advantages in improving the clinical pregnancy rate. CoQ10 was the best in improving the live birth rate (OR 2.36, 95% CI: 1.07 to 5.38). DHEA increased the embryo implantation rate (OR 2.80, 95%CI: 1.41 to 5.57) and the high-quality embryo rate (OR 2.01, 95% CI: 1.07 to 3.78) and number of oocytes retrieved (WMD 1.63, 95% CI: 0.34 to 2.92) showed a greater advantage, with GH in second place. Several adjuvant treatment strategies had no significant effect on reducing the cycle canceling rate compared with the control group. TEAS was the least effective of the four adjuvant treatments in most pooled results, but the overall effect appeared to be better than that of the control group.
CONCLUSIONS: Compared with COS regimen, the adjuvant use of CoQ10, DHEA and GH before IVF may have a better clinical effect on the pregnancy outcome of POR patients. TEAS needs careful consideration in improving the clinical pregnancy rate. Future large-scale RCTs with direct comparisons are needed to validate or update this conclusion.
BACKGROUND: PROSPERO CRD42022304723.
摘要：
背景：辅助生殖技术（ART）为不育患者带来了好消息，但如何改善卵巢低反应(POR)患者的妊娠结局仍是一个严峻的挑战,一些辅助治疗的科学证据仍存在争议.
目的：根据先前的证据，本系统综述和网络荟萃分析的目的是评估DHEA的效果，辅酶Q10、GH和TEAS对接受体外受精-胚胎移植(IVF-ET)的POR患者妊娠结局的影响.此外,我们的目的是确定目前POR的最佳辅助治疗策略.
方法：PubMed，Embase,Cochrane图书馆和中国的四个数据库(CNKI，万方,VIP,SinoMed）在2022年7月30日之前进行了系统搜索，没有语言限制。我们纳入了辅助治疗策略（DHEA，CoQ10，GH和TEAS）在IVF-ET之前改善POR患者的妊娠结局，而对照组仅接受控制性卵巢刺激(COS)方案。本研究是根据系统评价和荟萃分析（PRISMA）的首选报告项目进行报告的。累积排序曲线下的表面(SUCRA)用于提供每个结果的累积排序的汇集测量。
结果：16个RCT（2323名女性）使用博洛尼亚标准定义的POR纳入网络meta分析。与对照组相比,CoQ10(OR2.22,95%CI:1.05~4.71)和DHEA(OR1.92,95%CI:1.16~3.16)在提高临床妊娠率方面具有明显优势。CoQ10在提高活产率方面效果最好(OR2.36,95%CI:1.07~5.38)。DHEA提高了胚胎着床率(OR2.80,95CI:1.41~5.57)和优质胚胎率(OR2.01,95%CI:1.07~3.78)和卵母细胞回收数(WMD1.63,95%CI:0.34~2.92)显示出较大优势,GH排在第二位。与对照组相比，几种辅助治疗策略对降低周期取消率没有显着影响。在大多数汇总结果中，TEAS是四种辅助治疗中效果最差的，但总体效果似乎优于对照组。
结论：与COS方案相比，IVF前辅助使用CoQ10、DHEA和GH可能对POR患者的妊娠结局有较好的临床效果。TEAS在提高临床妊娠率时需要仔细考虑。未来需要使用直接比较的大规模随机对照试验来验证或更新这一结论。
背景：PROSPEROCRD42022304723.
目的：根据先前的证据，本系统综述和网络荟萃分析的目的是评估DHEA的效果，辅酶Q10、GH和TEAS对接受体外受精-胚胎移植(IVF-ET)的POR患者妊娠结局的影响.此外,我们的目的是确定目前POR的最佳辅助治疗策略.
方法：PubMed，Embase,Cochrane图书馆和中国的四个数据库(CNKI，万方,VIP,SinoMed）在2022年7月30日之前进行了系统搜索，没有语言限制。我们纳入了辅助治疗策略（DHEA，CoQ10，GH和TEAS）在IVF-ET之前改善POR患者的妊娠结局，而对照组仅接受控制性卵巢刺激(COS)方案。本研究是根据系统评价和荟萃分析（PRISMA）的首选报告项目进行报告的。累积排序曲线下的表面(SUCRA)用于提供每个结果的累积排序的汇集测量。
结果：16个RCT（2323名女性）使用博洛尼亚标准定义的POR纳入网络meta分析。与对照组相比,CoQ10(OR2.22,95%CI:1.05~4.71)和DHEA(OR1.92,95%CI:1.16~3.16)在提高临床妊娠率方面具有明显优势。CoQ10在提高活产率方面效果最好(OR2.36,95%CI:1.07~5.38)。DHEA提高了胚胎着床率(OR2.80,95CI:1.41~5.57)和优质胚胎率(OR2.01,95%CI:1.07~3.78)和卵母细胞回收数(WMD1.63,95%CI:0.34~2.92)显示出较大优势,GH排在第二位。与对照组相比，几种辅助治疗策略对降低周期取消率没有显着影响。在大多数汇总结果中，TEAS是四种辅助治疗中效果最差的，但总体效果似乎优于对照组。
结论：与COS方案相比，IVF前辅助使用CoQ10、DHEA和GH可能对POR患者的妊娠结局有较好的临床效果。TEAS在提高临床妊娠率时需要仔细考虑。未来需要使用直接比较的大规模随机对照试验来验证或更新这一结论。
背景：PROSPEROCRD42022304723.
