背景:据报道,子宫内输液治疗有利于胚胎植入和妊娠结局,并被认为是复发性植入失败(RIF)的不育患者的潜在治疗方法。然而,它们的效率存在争议,对于哪种宫内治疗最有效缺乏共识.
方法:所有前瞻性试验(中文或英文)均在PubMed数据库中检索,科克伦,WebofScience,和2013年7月至2023年7月的CNKI。我们纳入了调查各种子宫输注的研究,包括绒毛膜促性腺激素,粒细胞集落刺激因子,单核细胞,富血小板血浆,等。在IVF治疗期间,并报告了随后的妊娠结局。
结果:我们最终纳入了56项研究,包括40项随机对照试验,14项非随机对照试验,和3项前瞻性队列研究。本研究共包括11种子宫灌注方法:安慰剂,人绒毛膜促性腺激素(HCG),粒细胞集落刺激因子(G-CSF),富血小板血浆(PRP),外周血单核细胞(PBMC),生长激素(GH),地塞米松(DEX),胚胎培养上清液(ESC),PRP联合G-CSF(PRP+G-CSF),RPR联合皮下注射G-CSF(RPR+G-CSFsc),G-CSF联合皮下注射AXaIU(G-CSF+AXaIUsc)。宫内输注HCG,PBMC,G-CSF,与空白对照或安慰剂相比,PRP可显著改善反复植入失败患者的妊娠结局,PRP对临床妊娠和活产的改善最多。GH和ESC输注可能会改善妊娠结局,但子宫输注DEX表现为高流产。与单一疗法相比,联合疗法未显示出明显的优势。
结论:宫内输注HCG,PBMC,G-CSF,和PRP是改善反复植入失败的不孕患者妊娠结局的有希望的策略.在这些治疗中,PRP可能是最好的。需要更多的研究来探索药物组合和较少使用的药物的效果。
背景:我们的研究在PROSPERO注册,ID为CRD42023467188。
BACKGROUND: Intra-uterine infusion treatments were reported to be beneficial to embryo implantation and pregnancy outcomes, and considered as potential therapies for infertile patients with recurrent implantation failure (RIF). Nevertheless, their efficiencies were controversial and there lack of consensus on which intrauterine treatment is the most effective.
METHODS: All prospective trials (in Chinese or English) were searched in Databases PubMed, Cochrane, Web of Science, and CNKI from July 2013 to July 2023. We included studies that investigated various uterine infusions, including chorionic gonadotropin, granulocyte colony-stimulating factor, monocytes, platelet-rich plasma, etc. during IVF treatment and reported subsequent pregnancy outcomes.
RESULTS: We finally included 56 researches, including 40 randomized controlled trials, 14 non-randomized controlled trials, and 3 prospective cohort studies. This study included a total of 11 uterine perfusion methods: Placebo, Human Chorionic Gonadotropin (HCG), Granulocyte Colony-Stimulating Factor (G-CSF), platelet-rich plasma (PRP), Peripheral Blood Mononuclear Cell (PBMC), Growth hormone (GH), dexamethasone (DEX), Embryo culture supernatant (ESC), PRP combined with G-CSF (PRP + G-CSF), RPR combined with subcutaneous injection of G-CSF (RPR + G-CSFsc), G-CSF combined with subcutaneous injection of AXaIU (G-CSF + AXaIUsc). Intrauterine infusion of HCG, PBMC, G-CSF, and PRP significantly improves pregnancy outcomes in patients with repeated implantation failure compared with blank controls or placebo, and PRP improved the clinical pregnancy and live birth most. GH and ESC infusion might improve the pregnancy outcomes, but uterine infusion of DEX was shown with high miscarriage. The combination therapy did not show a significant advantage over the mono-therapy.
CONCLUSIONS: Intrauterine infusion of HCG, PBMC, G-CSF, and PRP are promising strategies for improving pregnancy outcomes for infertile patients with recurrent implantation failure. Among these treatments, PRP may be the best. More researches are required to explore the effect of drug combinations and less commonly used drugs as well.
BACKGROUND: Our study was registered in PROSPERO and the ID was CRD42023467188.