目的:SARSCov-2对IVF结局有什么影响?
结论:轻度或无症状的Covid-19感染似乎不会影响IVF后的临床或持续妊娠率。
背景:Covid-19已被证明会影响女性和男性的生育能力和生殖功能。研究表明,关于Covid-19对试管婴儿结局的影响的不同结果,很少报告卵巢储备受损,卵母细胞和胚胎质量,精液参数,临床妊娠率(CPR)和活产率(LBR),而其他报告对IVF结局无影响。
方法:PubMed的电子数据库搜索,EMBASE,Scopus,WHOCovid-19数据库,临床试验.gov和CochraneCentral在2020年1月1日至2022年10月15日期间由两名独立审稿人使用预定义的资格标准对英语发表的文章进行了研究。队列研究,以及病例对照研究和排除的叙述性评论,案例研究,成本效益研究或诊断研究。使用NOS评估偏倚风险,并通过GRADEpro对证据质量进行分级。
■包括比较接受IVF的女性以及比较受Covid-19影响的女性与未受Covid-19影响的女性的研究。此外,研究比较研究组中的免疫组(感染或接种疫苗)和未受影响的对照(历史对照,包括在Covid-19爆发前完成但与研究组匹配的IVF周期)。那些没有比较组或以英语以外的语言发表或重复研究的人被排除在外。
结果:我们确定了5046条记录,并对82项研究进行了全文筛选,选择了12项研究进行最终审查。对于临床妊娠率,covid康复或对照患者的CPR无差异(OR0.90,95%CI=0.67~1.21;I2=29%).同样,对植入率(RR0.92,95%CI=0.68~1.23;I2=31%)和持续妊娠率(RR0.96,95%CI=0.79~1.15;I2=21%)无显著影响.两组患者的平均卵母细胞数量没有显着差异(平均差异0.52,95%CI=-1.45至2.49;I2=75%)。证据的确定性很低。
结论:荟萃分析基于观察性研究,每个研究涉及少量参与者。很少有研究报告每个患者的结果,而其他研究报告每个周期,对于均匀性,我们报告了每个周期的结果。大多数研究的样本量很小。
结论:这项系统评价未显示与对照组相比,新冠肺炎康复后患者的IVF周期结局有任何显著影响。但是考虑到样本量,应谨慎考虑调查结果。
背景:审查协议已在PROSPERO上注册(注册号为CRD42022314515)。
OBJECTIVE: What is the effect of SARS Cov-2 on IVF outcome?
CONCLUSIONS: Mild or asymptomatic Covid-19 infection does not appear to affect clinical or ongoing pregnancy rate after IVF.
BACKGROUND: Covid-19 has been shown to affect female and male fertility and reproductive function. Studies have shown variable results regarding impact of Covid-19 on IVF outcome with few reporting impaired ovarian reserve, oocyte and embryo quality, semen parameters, clinical pregnancy rate (CPR) and live birth rate (LBR) while others reported no effect on IVF outcome.
METHODS: An electronic database search of PubMed, EMBASE, SCOPUS, WHO Covid-19 database, Clinical trials.gov and Cochrane Central was performed for articles published in English language between 1st January 2020 and 15th October 2022 by two independent reviewers using predefined eligibility criteria We have included observational studies both prospective and retrospective, cohort studies, and case control studies and excluded narrative reviews, case studies, cost-effectiveness studies or diagnostic studies. Risk of bias was assessed using NOS and quality of evidence was graded by GRADE pro.
UNASSIGNED: Studies comparing women undergoing IVF and comparing Covid-19 affected with those unaffected by Covid-19 were included. Also, studies comparing immune group (infected or vaccinated) in the study group and unaffected as controls (historical controls, IVF cycles done prior to Covid-19 outbreak but matched with study group) were included. Those with no comparison group or published in language other than English language or duplicate studies were excluded.
RESULTS: We identified 5046 records and after full text screening of 82 studies, 12 studies were selected for final review. For the clinical pregnancy rate, there was no difference in the CPR in covid recovered or control patients (OR 0.90, 95 % CI = 0.67 to1.21; I2 = 29 %). Similarly, there was no significant effect on implantation rate (RR 0.92, 95 % CI = 0.68 to1.23; I2 = 31 %) and ongoing pregnancy rate (RR 0.96, 95 % CI = 0.79 to 1.15;I2 = 21 %). The mean number of the oocyte retrieved per patient was not significantly different in both the groups (mean difference 0.52, 95 % CI = -1.45 to 2.49; I2 = 75 %). The certainty of the evidence was low.
CONCLUSIONS: The meta-analysis is based on observational studies each involving small number of participants. Few studies reported outcomes as per patient while others reported as per cycle, for uniformity we have reported outcomes as per cycle. Sample size in most of studies was small.
CONCLUSIONS: This systematic review has not shown any significant effect on the outcome of IVF cycles in patients post Covid-19 recovery compared to controls. But given the sample size, the findings should be considered with caution.
BACKGROUND: The review protocol has been registered on PROSPERO (registration number CRD42022314515).