目的:总结相关随机对照试验(RCT)的发现,并进行荟萃分析,探讨芳香化酶抑制剂在体外受精(IVF)不孕妇女中预防中重度卵巢过度刺激综合征(OHSS)的潜在作用。
方法:我们在电子数据库中搜索了相关的RCT,包括MEDLINE,Embase,Cochrane中央对照试验登记册(中央),和ClinicalTrials.gov(从成立到2023年8月)。此外,我们手动检索了相关综述和纳入研究的参考文献列表,以寻找进一步的相关研究.我们纳入了RCTs,其中芳香化酶抑制剂在控制性卵巢刺激(COS)或黄体早期开处方。Meta分析采用RevMan5.4.1软件进行。主要结果是中度至重度OHSS的发生率。在荟萃分析由于异质性或缺乏可比数据而不可行的情况下进行描述性分析。
结果:检索到2858条记录,最终纳入12个随机对照试验。来曲唑在治疗组在COS期间进行了7次RCT,而在5个RCT的黄体早期。与对照组相比,来曲唑组中度至重度OHSS的风险显着降低了55%(RR0.45,95%CI0.32至0.64,I2=0%,5个随机对照试验,494名患者)。此外,HCG触发日的血清雌二醇(E2)水平随着COS期间来曲唑的给药而显着降低(MD-847.23,95%CI-1398.00至-296.47,I2=93%,5个随机对照试验,374名患者)。四号的血清E2水平,在黄体早期给药来曲唑时,hCG触发后第5天和第7天至第10天也显着低于对照组。
结论:OHSS高危患者可能受益于来曲唑,本系统评价揭示了降低中度至重度OHSS的发生率。然而,参与者数量非常有限,纳入研究的质量不允许推荐来曲唑预防重度OHSS.
OBJECTIVE: To summarize the findings of relevant randomized controlled trials (RCTs) and conduct a meta-analysis to investigate the potential effect of aromatase inhibitors on preventing moderate to severe ovarian hyperstimulation syndrome (OHSS) in infertile women undergoing in vitro fertilization (IVF).
METHODS: We searched for relevant RCTs in electronic databases, including MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and ClinicalTrials.gov (from inception to August 2023). In addition, we manually searched the related reviews and reference lists of included studies for further relevant studies. We included RCTs where aromatase inhibitors prescribed either during controlled ovarian stimulation (COS) or in early luteal phase. The meta-analysis was performed using RevMan 5.4.1 software. The primary outcome was the incidence of moderate to severe OHSS. A descriptive analysis was conducted in cases where a meta-analysis was not feasible due to heterogeneity or lack of comparable data.
RESULTS: 2858 records were retrieved and 12 RCTs were finally included. Letrozole was administered in the treatment group during COS in seven RCTs, whereas in the early luteal phase in five RCTs. Compared with the control group, the risk of moderate to severe OHSS significantly reduced by 55% in the letrozole group (RR 0.45, 95% CI 0.32 to 0.64, I2 = 0%, 5 RCTs, 494 patients). Moreover, serum estradiol (E2) levels on hCG trigger day significantly decreased with the administration of letrozole during COS (MD -847.23, 95% CI -1398.00 to -296.47, I2 = 93%, 5 RCTs, 374 patients). And serum E2 levels on the 4th, 5th and 7th to 10th day after hCG trigger were also significantly lower than those in the control group when letrozole was administered in the early luteal phase.
CONCLUSIONS: Patients with high risk of OHSS probably benefit from letrozole, which has been revealed to reduce the incidence of moderate to severe OHSS by this systematic review. However, the very limited number of participants and the quality of the included studies does not allow to recommend letrozole for the prevention of severe OHSS.