Human chorionic gonadotropin administration vs. luteinizing monitoring for intrauterine insemination timing, after administration of clomiphene citrate: a meta-analysis
Human chorionic gonadotropin administration vs. luteinizing monitoring for intrauterine insemination timing, after administration of clomiphene citrate: a meta-analysis
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DOI：
10.1016/j.fertnstert.2006.10.003
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发表时间：
2007-03-01
影响因子：
6.7
通讯作者：
Devroey, Paul
中科院分区：
文献类型：
--
作者：
Kosmas, Ioannis P.;Tatsioni, Athina;Devroey, Paul
目的：系统地比较hCG给药作为宫内授精（IUI）时机选择的方法与保守性尿LH峰检测在不孕症治疗中的作用。设计：前瞻性和回顾性试验的荟萃分析。设置：三级生育和IVF中心。患者：1461名患者在克罗米芬治疗后接受hCG治疗，162例IUI时机检测到LH峰的患者。干预：检索MEDLINE和科克伦协作网。检索文献的参考文献纳入检索。荟萃分析包括所有对照试验，检查与LH检测相比，IUI前hCG给药对临床妊娠率的有效性。两名独立的评审员进行了数据提取。主要结果测量：妊娠率。结果：7项研究，2，623例患者被纳入荟萃分析（1，461例患者接受hCG，1，162例患者进行LH峰检测）。当所有的研究结合起来，在IUI之前接受hCG的患者表现出比在自发排卵后接受IUI的女性更低的临床妊娠率（比值比，0.74; 95%置信区间，0.57-0.961）。在对认为排卵功能障碍是不孕原因的研究进行的亚组分析中，结果有利于接受hCG的妇女。相反，在报告男性因素为不孕原因的研究中，以及在包括不明原因不孕妇女的研究中，结果似乎有利于LH峰检测方法。然而，这些亚组分析均未达到统计学显著性。结论（S）：现有数据并未表明，与自发排卵相比，hCG诱导排卵在IUI时机方面具有一致的、临床重要的益处。（Fertil Steril（R）2007;87：607-12. (c)2007年，美国生殖医学会（American Society for Reproductive Medicine）
Objective: To systematically compare hCG administration as a method for intrauterine insemination (IUI) timing with conservative urinary LH surge detection in infertility treatment.Design: Meta-analysis of prospective and retrospective trials.Setting: Tertiary fertility and IVF center.Patient(s): One thousand four hundred sixty-one patients who received hCG after a clomiphene citrate regimen, compared with 1,162 patients who had an LH surge detection for IUI timing.Intervention(s): Both MEDLINE and Cochrane Collaboration were searched. References of retrieved articles were included in the search. The meta-analysis included all controlled trials examining the effectiveness of hCG administration before IUI on clinical-pregnancy rates in comparison with LH detection. Two independent reviewers performed data extraction.Main Outcome Measure(s): Pregnancy rates.Result(s): Seven studies with 2,623 patients were included in the meta-analysis (1,461 patients received hCG, and 1,162 had LH surge detection). When all studies were combined, patients who received hCG before IUI demonstrated lower clinical-pregnancy rates than did women who had IUI after spontaneous ovulation (odds ratio, 0.74; 95% confidence interval, 0.57-0.961). In subgroup analysis of studies that considered ovulatory dysfunction to be the infertility reason, the results favored women who received hCG. In contrast, across studies that reported male factor as the infertility reason, as well as across studies including women with unexplained infertility, results appeared to favor the LH surge detection approach. However, none of those subgroup analyses reached statistical significance.Conclusion(S): Available data do not demonstrate a consistent, clinically important benefit of hCG-induced ovulation compared with spontaneous ovulation for IUI timing. (Fertil Steril (R) 2007;87:607-12. (c) 2007 by American Society for Reproductive Medicine.)