目的:子宫腺肌病可以减少辅助受孕妇女的临床妊娠机会。推测在IVF/ICSI之前用促性腺激素释放激素类似物(GnRHa)下调治疗可改善妊娠结局。
目的:我们旨在通过系统评价和荟萃分析,评估延长GnRHa治疗(至少1个月)与未预先治疗的子宫腺肌病患者IVF/ICSI的有效性和安全性。
方法:我们搜索了电子数据库:Embase(OVID),MEDLINE®(OVID),APAPsycInfo(OVID),妇幼保健数据库(MIDIRS(OVID),HMIC健康管理信息联盟(OVID)和ClinicalTrials.gov从成立到2023年3月27日。
我们纳入了关于子宫腺肌病妇女在IVF/ICSI前接受GnRHa下调下丘脑-垂体-卵巢轴1-6个月的研究。我们使用Haensel-Mantel方法汇总数据,并使用OddsRatio(OR)和95%置信区间(CI)进行报告。我们使用纽卡斯尔-奥托瓦量表评估纳入研究的质量,并使用GRADE标准评估证据的可信度。偏差分析是通过Cochrane推荐的工具(RevManWeb,学术许可证)。
结果:我们筛选了365篇引文,其中8篇回顾性研究纳入meta分析(n=2422名女性)。中位年龄为34岁[IQR31.95-35.05],BMI中位数21.30kg/m2[IQR21.05-23.55],GnRHa下调持续时间中位数为2.5个月[范围1-4;IQR1.37-3].子宫腺肌病女性接受延长GnRHa治疗的植入率较高1/OR1.69[95%CI1.09,2.56],I2=81%,(P=0.02)和临床妊娠率1/OR1.42[95%CI1.03,2.0],I270%,P=0.03。活产率1/OR1.12[95%CI0.70,1.79]没有总体差异,I2=78%,p=0.63),流产率1/OR0.92[95%CI0.63,1.28,P=0.61,I20%或平均检索卵母细胞数(10个卵母细胞[IQR8.95;11.15]vs.9.28[IQR8;10.20],组间p=0.22)。
结论:根据现有的回顾性研究,延长GnRHa治疗对子宫腺肌病患者进行辅助受孕治疗的益处尚不确定。在该人群中,长期下调后,植入和临床妊娠率较高,尽管活产和流产率没有统计学上的显着差异。鉴于有限,低质量的现有数据,需要一个精心设计的,前瞻性随机对照试验,以精确评估延长GnRHa治疗在该人群中的有效性。
OBJECTIVE: Adenomyosis can reduce the chance of clinical pregnancy in women undergoing assisted conception. Treatment with prolonged gonadotrophin-releasing hormone analogue (GnRHa) downregulation prior to IVF/ICSI has been postulated to improve pregnancy outcomes.
OBJECTIVE: We aimed to evaluate the effectiveness and safety of prolonged GnRHa treatment (minimum one month) versus no pre-treatment in women with
adenomyosis undergoing IVF/ICSI using a systematic review and meta-analysis.
METHODS: We searched electronic databases: Embase (OVID), MEDLINE® (OVID), APA PsycInfo (OVID), Maternity & Infant Care Database (MIDIRS (OVID), HMIC Health Management Information Consortium (OVID) and ClinicalTrials.gov from inception until 27th of March 2023.
UNASSIGNED: We included studies that reported on women with
adenomyosis receiving GnRHa to down-regulate the hypothalamic-pituitary-ovarian axis for one to six months before IVF/ICSI. We pooled data using the Haensel-Mantel method and reported using Odds Ratio (OR) with 95 % confidence intervals (CI). We assessed the quality of included studies using the Newcastle-Ottowa Scale and confidence in evidence using the GRADE criteria. Bias analysis was conducted via the Cochrane recommended tool (RevMan Web, Academic License).
RESULTS: We screened 365 citations and eight retrospective studies were included in the meta-analysis (n = 2422 women). The median age was 34 years [IQR 31.95-35.05], median BMI 21.30 kg/m2 [IQR 21.05-23.55] and median duration of GnRHa downregulation was 2.5 months [Range 1-4; IQR 1.37-3]. Women with
adenomyosis receiving prolonged GnRHa treatment had a higher implantation rate 1/OR 1.69 [95 % CI 1.09, 2.56], I2 = 81 %, (P = 0.02) and clinical pregnancy rate 1/OR 1.42 [95 % CI 1.03, 2.0], I2 70 %, P = 0.03. There was no overall difference in live birth rate 1/OR 1.12 [95 % CI 0.70, 1.79], I2 = 78 %, p = 0.63), miscarriage rate 1/OR 0.92 [95 % CI 0.63, 1.28, P = 0.61, I2 0 % or mean number of oocytes retrieved (10 oocytes [IQR 8.95; 11.15] vs. 9.28 [IQR 8; 10.20], p = 0.22) between groups.
CONCLUSIONS: The benefit of prolonged GnRHa treatment in women with
adenomyosis undergoing assisted conception treatment is uncertain based on existing retrospective studies. Implantation and clinical pregnancy rates were higher following prolonged downregulation in this population, though there was no statistically significant difference in live birth and miscarriage rates. Given the limited, low-quality existing data, there is a need for a well-designed, prospective randomised controlled trial to precisely evaluate the effectiveness of prolonged GnRHa treatment in this population.