PDF(Pubmed)
Abstract：
UNASSIGNED: Despite the developments of in vitro fertilization (IVF) protocols, implantation failure remains a challenging problem, owing to the unbalance between the embryo, endometrium, and immune system interactions. Effective treatments are urgently required to improve successful implantation. Recently, many researchers have focused on granulocyte colony-stimulating factor (G-CSF) to regulate immune response and embryo-endometrium cross-talk. However, previous studies have reported inconsistent findings on the efficacy of G-CSF therapy on implantation failure. The objective of this review was to further explore the effects of G-CSF according to administration dosage and timing among women who experienced at least one implantation failure.
UNASSIGNED: We systematically searched MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, Scopus, and Web of Science for randomized controlled trials of G-CSF on implantation failure up to July 21, 2023. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated and the heterogeneity of the studies with the I2 index was analyzed.
UNASSIGNED: We identified a total of 2031 studies and finally included 10 studies in the systematic review and meta-analysis. G-CSF administration improved the clinical pregnancy rate (CPR), implantation rate (IR), biochemical pregnancy rate (BPR), and live birth rate (LBR) in women with at least one implantation failure. Subgroup analyses showed that G-CSF treatment could exert good advantages in improving CPR [OR=2.49, 95%CI (1.56, 3.98), I2 = 0%], IR [OR=2.82, 95%CI (1.29, 6.15)], BPR [OR=3.30, 95%CI (1.42, 7.67)] and LBR [OR=3.16, 95%CI (1.61, 6.22), I2 = 0%] compared with the blank control group. However, compared with placebo controls, G-CSF showed beneficial effects on CPR [OR=1.71, 95%CI (1.04, 2.84), I2 = 38%] and IR [OR=2.01, 95%CI (1.29, 3.15), I2 = 24%], but not on LBR. In addition, >150μg of G-CSF treatment increased CPR [OR=2.22, 95%CI (1.47, 3.35), I2 = 0%], IR [OR=2.67, 95%CI (1.47, 4.82), I2 = 0%] and BPR [OR=2.02, 95%CI (1.17, 3.47), I2 = 22%], while ≤150μg of G-CSF treatment improved miscarriage rate (MR) [OR=0.14, 95%CI (0.05, 0.38), I2 = 0%] and LBR [OR=2.65, 95%CI (1.56, 4.51), I2 = 0%]. Moreover, G-CSF administration on the day of embryo transfer (ET) could increase CPR [OR=2.81, 95%CI (1.37, 5.75), I2 = 0%], but not on the day of ovum pick-up (OPU) or human chorionic gonadotropin (HCG) injection.
UNASSIGNED: G-CSF has a beneficial effect on pregnancy outcomes to some extent among women who experienced at least one implantation failure, and the administration dosage and timing influence the effect size.Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42023447046.
UNASSIGNED: We systematically searched MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, Scopus, and Web of Science for randomized controlled trials of G-CSF on implantation failure up to July 21, 2023. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated and the heterogeneity of the studies with the I2 index was analyzed.
UNASSIGNED: We identified a total of 2031 studies and finally included 10 studies in the systematic review and meta-analysis. G-CSF administration improved the clinical pregnancy rate (CPR), implantation rate (IR), biochemical pregnancy rate (BPR), and live birth rate (LBR) in women with at least one implantation failure. Subgroup analyses showed that G-CSF treatment could exert good advantages in improving CPR [OR=2.49, 95%CI (1.56, 3.98), I2 = 0%], IR [OR=2.82, 95%CI (1.29, 6.15)], BPR [OR=3.30, 95%CI (1.42, 7.67)] and LBR [OR=3.16, 95%CI (1.61, 6.22), I2 = 0%] compared with the blank control group. However, compared with placebo controls, G-CSF showed beneficial effects on CPR [OR=1.71, 95%CI (1.04, 2.84), I2 = 38%] and IR [OR=2.01, 95%CI (1.29, 3.15), I2 = 24%], but not on LBR. In addition, >150μg of G-CSF treatment increased CPR [OR=2.22, 95%CI (1.47, 3.35), I2 = 0%], IR [OR=2.67, 95%CI (1.47, 4.82), I2 = 0%] and BPR [OR=2.02, 95%CI (1.17, 3.47), I2 = 22%], while ≤150μg of G-CSF treatment improved miscarriage rate (MR) [OR=0.14, 95%CI (0.05, 0.38), I2 = 0%] and LBR [OR=2.65, 95%CI (1.56, 4.51), I2 = 0%]. Moreover, G-CSF administration on the day of embryo transfer (ET) could increase CPR [OR=2.81, 95%CI (1.37, 5.75), I2 = 0%], but not on the day of ovum pick-up (OPU) or human chorionic gonadotropin (HCG) injection.
UNASSIGNED: G-CSF has a beneficial effect on pregnancy outcomes to some extent among women who experienced at least one implantation failure, and the administration dosage and timing influence the effect size.Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42023447046.
摘要：
■尽管体外受精（IVF）方案的发展，植入失败仍然是一个具有挑战性的问题，由于胚胎之间的不平衡，子宫内膜,和免疫系统相互作用。迫切需要有效的治疗来提高成功的植入。最近,许多研究者关注粒细胞集落刺激因子(G-CSF)来调节免疫应答和胚胎-子宫内膜串扰.然而,以前的研究报道了关于G-CSF治疗植入失败疗效的不一致发现.这篇综述的目的是进一步探讨G-CSF根据给药剂量和时机在至少经历过一次植入失败的女性中的作用。
■我们系统地搜索了MEDLINE，Embase,Cochrane中央受控试验登记册,Scopus,和WebofScience进行G-CSF关于植入失败的随机对照试验，直至2023年7月21日。计算了赔率比（ORs）和95％置信区间（CIs），并分析了具有I2指数的研究的异质性。
■我们总共确定了2031项研究，最后在系统评价和荟萃分析中纳入了10项研究。G-CSF给药提高了临床妊娠率（CPR），植入率（IR），生化妊娠率（BPR），和活产率（LBR）的妇女至少有一个植入失败。亚组分析表明，G-CSF治疗在改善CPR方面具有良好的优势[OR=2.49，95CI（1.56，3.98），I2=0%]，IR[OR=2.82，95CI（1.29，6.15）]，BPR[OR=3.30,95CI(1.42,7.67)]和LBR[OR=3.16,95CI(1.61,6.22),I2=0%]与空白对照组比较。然而,与安慰剂对照相比，G-CSF对CPR显示出有益作用[OR=1.71，95CI（1.04，2.84），I2=38%]和IR[OR=2.01，95CI（1.29，3.15），I2=24%]，但不是在LBR上。此外,>150μg的G-CSF治疗增加CPR[OR=2.22,95CI(1.47,3.35),I2=0%]，IR[OR=2.67，95CI（1.47，4.82），I2=0%]和BPR[OR=2.02，95CI（1.17，3.47），I2=22%]，而≤150μg的G-CSF治疗改善了流产率（MR）[OR=0.14，95CI（0.05，0.38），I2=0%]和LBR[OR=2.65，95CI（1.56，4.51），I2=0%]。此外，胚胎移植（ET）当天给予G-CSF可以增加CPR[OR=2.81，95CI（1.37，5.75），I2=0%]，但不在取卵（OPU）或人绒毛膜促性腺激素（HCG）注射当天。
■G-CSF在一定程度上对经历至少一次植入失败的女性的妊娠结局有有益的影响，给药剂量和时机影响效果大小。系统审查注册：https://www。crd.约克。AC.英国/普华永道/，标识符CRD42023447046。
■我们系统地搜索了MEDLINE，Embase,Cochrane中央受控试验登记册,Scopus,和WebofScience进行G-CSF关于植入失败的随机对照试验，直至2023年7月21日。计算了赔率比（ORs）和95％置信区间（CIs），并分析了具有I2指数的研究的异质性。
■我们总共确定了2031项研究，最后在系统评价和荟萃分析中纳入了10项研究。G-CSF给药提高了临床妊娠率（CPR），植入率（IR），生化妊娠率（BPR），和活产率（LBR）的妇女至少有一个植入失败。亚组分析表明，G-CSF治疗在改善CPR方面具有良好的优势[OR=2.49，95CI（1.56，3.98），I2=0%]，IR[OR=2.82，95CI（1.29，6.15）]，BPR[OR=3.30,95CI(1.42,7.67)]和LBR[OR=3.16,95CI(1.61,6.22),I2=0%]与空白对照组比较。然而,与安慰剂对照相比，G-CSF对CPR显示出有益作用[OR=1.71，95CI（1.04，2.84），I2=38%]和IR[OR=2.01，95CI（1.29，3.15），I2=24%]，但不是在LBR上。此外,>150μg的G-CSF治疗增加CPR[OR=2.22,95CI(1.47,3.35),I2=0%]，IR[OR=2.67，95CI（1.47，4.82），I2=0%]和BPR[OR=2.02，95CI（1.17，3.47），I2=22%]，而≤150μg的G-CSF治疗改善了流产率（MR）[OR=0.14，95CI（0.05，0.38），I2=0%]和LBR[OR=2.65，95CI（1.56，4.51），I2=0%]。此外，胚胎移植（ET）当天给予G-CSF可以增加CPR[OR=2.81，95CI（1.37，5.75），I2=0%]，但不在取卵（OPU）或人绒毛膜促性腺激素（HCG）注射当天。
■G-CSF在一定程度上对经历至少一次植入失败的女性的妊娠结局有有益的影响，给药剂量和时机影响效果大小。系统审查注册：https://www。crd.约克。AC.英国/普华永道/，标识符CRD42023447046。
