目的:尽管许多试验已经评估了使用脱氢表雄酮改善接受辅助生殖技术治疗的不良反应者的结局,支持这种方法的证据是有争议的。我们旨在对现有已发表的数据进行系统评价和荟萃分析,以进一步阐明和补充脱氢表雄酮(DHEA)的使用,以提高卵巢储备功能下降或卵巢不良反应患者体外受精的有效性。
方法:PubMed,Embase,科克伦图书馆,并在2020年12月搜索了WebofScience数据库。卵母细胞产量,中期II卵母细胞,受精的卵母细胞,高质量的胚胎,临床妊娠率,持续怀孕率,和活产率作为相对结局进行分析.进行荟萃分析,并对固定效应模型和随机效应模型进行拟合。
结果:8项前瞻性随机对照研究,五项前瞻性病例对照研究,我们共对1998名参与者进行了3项回顾性队列研究.这些研究的荟萃分析表明,获得的卵母细胞数量明显更高(WMD1.09,95%CI0.38至1.80),中期II卵母细胞(WMD0.78,95%CI0.16至1.40),受精卵母细胞(WMD0.84,95%CI0.42至1.26),优质胚胎(WMD0.60,95%CI0.34至0.86),临床妊娠率(RR1.35,95%CI1.13至1.61),和持续妊娠率(RR1.82,95%CI1.34至2.46),尽管与对照组相比,DHEA补充组的活产率没有差异(RR1.35,95%CI0.94至1.94)。
结论:口服补充DHEA似乎可以改善一些IVF结局。基于这些有限的证据,我们得出的结论是,需要进一步的研究才能提供足够的数据。
Although many trials have evaluated the use of dehydroepiandrosterone to improve outcomes in poor responders undergoing assisted reproductive technology treatment, evidence supporting this approach is controversial. We aimed to conduct a systematic
review and meta-analysis of existing published data to further elucidate and supplement the use of Dehydroepiandrosterone (DHEA) to improve the effectiveness of vitro fertilization in patients with diminished ovarian reserve or adverse ovarian reactions.
PubMed, Embase, Cochrane Library, and the Web of Science databases were searched through December 2020. Oocyte yield, metaphase II oocytes, fertilized oocytes, top-quality embryos, clinical pregnancy rate, ongoing pregnancy rate, and live birth rate were analyzed as relative outcomes. Meta-analysis was performed and fitted to both fixed-effects models and random-effects models.
Eight prospective randomized controlled studies, five prospective case-control studies, and three retrospective cohort studies were conducted with a total of 1998 participants. Meta-analyses of these studies showed a significantly higher number of oocytes retrieved (WMD 1.09, 95% CI 0.38 to 1.80), metaphase II oocytes (WMD 0.78, 95% CI 0.16 to 1.40), fertilized oocytes (WMD 0.84, 95% CI 0.42 to 1.26), top-quality embryos (WMD 0.60, 95% CI 0.34 to 0.86), clinical pregnancy rate (RR 1.35, 95% CI 1.13 to 1.61), and ongoing pregnancy rate (RR 1.82, 95% CI 1.34 to 2.46), although there was no difference in live birth rate (RR 1.35, 95% CI 0.94 to 1.94) in the DHEA supplementation groups compared with that in the control groups.
Oral DHEA supplementation appears to improve some IVF outcomes. On the basis of this limited evidence, we conclude that further studies are required to provide sufficient data.