How to improve the probability of pregnancy in poor responders undergoing in vitro fertilization: a systematic review and meta-analysis
How to improve the probability of pregnancy in poor responders undergoing in vitro fertilization: a systematic review and meta-analysis
复制标题
DOI：
10.1016/j.fertnstert.2007.12.077
复制
发表时间：
2009-03-01
影响因子：
6.7
通讯作者：
Tarlatzis, Basil C.
中科院分区：
文献类型：
--
作者：
Kyrou, Dimitra;Kolibianakis, Efstratios M.;Tarlatzis, Basil C.
目的：系统地回顾文献，以确定随机对照试验，这些试验评价旨在提高接受体外受精（IVF）的不良反应者妊娠概率的干预措施。设计：系统回顾和荟萃分析。设置：大学医院。干预措施：无。主要结局指标：妊娠率。结果：确定了22项合格的随机对照试验，共评估了15项干预措施，以增加不良反应者的妊娠率。根据有限的证据，唯一似乎可以增加怀孕可能性的干预措施是在卵巢刺激中添加GH（活产的比值比：5.22，置信区间：95% 1.09-24.99）和第2天与第3天相比的胚胎移植性能（继续妊娠率：分别为27.7%和16.3%;差异：+11.4，95%置信区间：+1.6至+21.0）。结论：没有足够的证据推荐大多数用于改善不良反应者妊娠率的治疗。目前，有一些证据表明，添加生长激素，以及在第2天与第3天进行胚胎移植，似乎可以提高怀孕的可能性。（Fertil Steril（R）2009;91：749-66. (C)2009年，美国生殖医学会（American Society for Reproductive Medicine）
Objective: To systematically review the literature to identify randomized controlled trials, which evaluate interventions aiming to improve the probability of pregnancy in poor responders undergoing in vitro fertilization (IVF).Design: Systematic review and meta-analysis.Setting: University-based hospital.Intervention(s): None.Main Outcome Measure(s): Pregnancy rate.Result(s): Twenty-two eligible randomized controlled trials were identified that evaluated in total 15 interventions to increase pregnancy rates in poor responders. Based on limited evidence, the only interventions that appear to increase the probability of pregnancy were the addition of GH to ovarian stimulation (odds ratio for live birth: 5.22, confidence interval: 95% 1.09-24.99) and the performance of embryo transfer on day 2 compared with day 3 (ongoing pregnancy rate: 27.7% vs. 16.3%, respectively; difference: +11.4, 95% confidence interval: +1.6 to +2 1.0).Conclusion(s): Insufficient evidence exists to recommend most of the treatments proposed to improve pregnancy rates in poor responders. Currently, there is some evidence to suggest that addition of GH, as well as performing embryo transfer on day 2 versus day 3, appear to improve the probability of pregnancy. (Fertil Steril (R) 2009;91: 749-66. (C) 2009 by American Society for Reproductive Medicine.)