目的:子宫腺肌病患者体外受精/卵胞浆内单精子注射(IVF/ICSI)不同卵巢刺激方案的妊娠结局并不明确。这项荟萃分析旨在系统评估不同IVF/ICSI方案对妊娠结局的影响。
方法:Meta分析。
方法:PubMed,截至2023年10月,搜索了WebofScience和Cochrane图书馆。
方法:子宫腺肌病人群IVF/ICSI结局的比较研究符合资格。植入前基因检测的研究,reviews,病例报告和动物实验被排除.
方法:有效信息由两名独立作者根据标准数据格式提取。所有分析均使用ReviewManager(RevMan,V.3.3).
结果:与非子宫腺肌病人群相比,子宫腺肌病导致临床妊娠率下降26%(CPR;42.47%vs55.89%,OR:0.74,95%CI:0.66至0.82,p<0.00001),活产率降低35%(LBR;30.72%对47.77%,OR:0.65,95%CI:0.58至0.73,p<0.00001),流产率增加1.9倍(MR;27.82%vs13.9%,OR:1.90,95%CI:1.56至2.31,p<0.00001)。亚组分析表明,在新鲜胚胎移植(ET)周期中,长/短/拮抗剂方案组的CPR(34.4%vs58.25%)低于ultralong方案组.在冻结ET(FET)循环中,CPR((GnRHaFET)AM(子宫腺肌病)与非AM无统计学差异:51.32%vs43.48%,p=0.31;(非GnRHa+FET)AM与非AM:50.25%vs60.10%,p=0.82),MR((GnRHa+FET)AM与非AM:12.82%对12.50%,p=0.97;(非GnRHa+FET)AM与非AM:30.5%vs15.54%,p=0.15)和LBR((GnRHa+FET)AM与非AM:44.74%与36.96%,p=0.31;(非GnRHa+FET)AM与非AM:34.42%vs50.25%,p=0.28)。在新鲜的ET和FET周期中,子宫腺肌病组的MR较高。
结论:FET可能是子宫腺肌病女性的更好选择,尤其是那些用GnRHa预处理的.在新鲜的ET周期中,长/短/拮抗剂方案的妊娠结局比Ultralong方案差.
背景:CRD420223440743.
OBJECTIVE: Pregnancy outcomes of different ovarian stimulation protocols for in vitro fertilisation/intracytoplasmic sperm injection (IVF/ICSI) in patients with adenomyosis are not explicit. This meta-analysis aimed to systematically evaluate the effects of different IVF/ICSI protocols on pregnancy outcomes.
METHODS: Meta-analysis.
METHODS: PubMed, Web of Science and Cochrane library were searched up to October 2023.
METHODS: Comparative studies on IVF/ICSI outcomes in the adenomyosis population were eligible. Studies on preimplantation genetic testing, reviews, case reports and animal experiments were excluded.
METHODS: Valid information was extracted by two independent authors according to a standard data format. All analyses were conducted using Review Manager (RevMan, V.5.3).
RESULTS: Compared with the non-adenomyosis population, adenomyosis was responsible for a 26% reduction in clinical pregnancy rate (CPR; 42.47% vs 55.89%, OR: 0.74, 95% CI: 0.66 to 0.82, p<0.00001), a 35% reduction in live birth rate (LBR; 30.72% vs 47.77%, OR: 0.65, 95% CI: 0.58 to 0.73, p<0.00001) and a 1.9-fold increase in miscarriage rate (MR; 27.82% vs 13.9%, OR: 1.90, 95% CI: 1.56 to 2.31, p<0.00001). Subgroup analysis suggested that, in fresh embryo transfer (ET) cycles, the CPR (34.4% vs 58.25%) in the long/short/antagonist protocol group was poorer than that in the ultralong protocol group. In frozen ET (FET) cycles, there were no statistical differences in CPR ((GnRHa+FET) AM(adenomyosis) vs non-AM: 51.32% vs 43.48%, p=0.31; (non-GnRHa+FET) AM vs non-AM: 50.25% vs 60.10%, p=0.82), MR ((GnRHa+FET) AM vs non-AM:12.82% vs 12.50%, p=0.97; (non-GnRHa+FET) AM vs non-AM: 30.5% vs 15.54%, p=0.15) and LBR ((GnRHa+FET) AM vs non-AM:44.74% vs 36.96%, p=0.31; (non-GnRHa+FET) AM vs non-AM: 34.42% vs 50.25%, p=0.28). The MR in the adenomyosis group was high in the fresh ET and FET cycles.
CONCLUSIONS: FET might be a better choice for women with adenomyosis, especially those pretreated with GnRHa. In fresh ET cycles, pregnancy outcomes of the long/short/antagonist protocols were poorer than those of the ultralong protocol.
BACKGROUND: CRD42022340743.