目的:在自然周期冷冻胚胎移植(NC-FET)周期中补充黄体酮用于黄体期支持(LPS)的必要性值得进一步确认。
目的:研究补充孕酮对接受NC-FET周期的患者生殖结局的影响。
方法:PubMed,Ovid-Embase,科克伦图书馆,WebofScience,CNKI,万方,VIP,和CBM进行了电子搜索。搜索时间范围是从开始到2022年9月。
UNASSIGNED:在NC-FET循环中使用孕酮进行LPS的RCT,包括真正的NC-FET循环(tNC-FET)和修改的NC-FET循环(mNC-FET),包括在内。使用相对风险(RR)作为效应大小统计量对计数数据进行分析,每个效应大小被分配其95%置信区间(CI)。
结果:主要结局是活产率(LBR)和临床妊娠率(CPR),次要结局是流产率(MR)。
结果:纳入4项随机对照试验(RCT),其中涉及1116名参与者。荟萃分析结果表明,补充孕酮与LBR增加有关(RR1.42,95%CI1.15-1.75,I2=0%,中等质量证据)和CPR(RR1.30,95%CI1.07-1.57,I2=0%,中等质量证据)在接受NC-FET周期的患者中。亚组分析显示,在tNC-FET周期中,补充孕酮与较高的LBR和CPR相关。然而,在mNC-FET周期中,未发现LBR升高和CPR升高之间存在关联.此外,在mNC-FET周期中,与阴道孕酮相比,只有一项RCT报告口服地屈孕酮的CPR和MR相似.
结论:总体而言,中等质量的证据表明,在NC-FET周期中,补充孕酮治疗LPS与LBR和CPR增加相关.在tNC-FET周期中,补充孕酮与较高的LBR和CPR相关。然而,mNC-FET周期中补充孕酮的有效性应通过更大的随机对照试验进一步验证.低到极低质量的证据表明,口服地屈孕酮和阴道孕酮在mNC-FET周期中具有相似的生殖结果,这需要进一步研究,特别是在tNC-FET周期。
The necessity of progesterone supplementation for luteal phase support (LPS) in natural cycle frozen embryo transfer (NC-FET) cycles warrants further confirmation.
To investigate the effect of progesterone supplementation for LPS on the reproductive outcomes of patients undergoing NC-FET cycles.
The PubMed, Ovid-Embase, Cochrane Library, Web of Science, CNKI, Wanfang, VIP, and CBM were electronically searched. The search time frame was from inception up to September 2022.
Randomized controlled trials (RCTs) that used progesterone for LPS in NC-FET cycles, including true NC-FET cycles (tNC-FET) and modified NC-FET cycles (mNC-FET), were included. The counted data were analyzed using relative risk (RR) as the effect-size statistic, and each effect size was assigned its 95% confidence interval (CI).
The primary outcomes were the live birth rate (LBR) and the clinical pregnancy rate (CPR), and the secondary outcome was the miscarriage rate.
Four RCTs were included, which involved 1116 participants. The results of the meta-analysis showed that progesterone supplementation was associated with increased LBR (RR, 1.42; 95% CI, 1.15-1.75; I2 = 0%, moderate-quality evidence) and CPR (RR, 1.30, 95% CI, 1.07-1.57; I2 = 0%, moderate-quality evidence) in patients undergoing NC-FET cycles. Subgroup analysis showed that progesterone supplementation was associated with higher LBR and CPR in tNC-FET cycles. However, no association was found between increased LBR and CPR in mNC-FET cycles. In addition, only one RCT reported that oral dydrogesterone had similar CPR and miscarriage rate compared with vaginal progesterone in mNC-FET cycles.
Overall, moderate-quality evidence suggested that progesterone supplementation for LPS was associated with increased LBR and CPR in NC-FET cycles. Progesterone supplementation was associated with a higher LBR and CPR in tNC-FET cycles. However, the effectiveness of progesterone supplementation in mNC-FET cycles should be further verified by larger RCTs. Low to very low-quality evidence indicated that oral dydrogesterone and vaginal progesterone have similar reproductive outcomes in mNC-FET cycles, which requires further study, especially in tNC-FET cycles.
PROSPERO CRD42022355550 (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=355550) was registered on September 3, 2022.