The likelihood of live birth and multiple birth after single versus double embryo transfer at the cleavage stage: a systematic review and meta-analysis
The likelihood of live birth and multiple birth after single versus double embryo transfer at the cleavage stage: a systematic review and meta-analysis
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DOI：
10.1016/j.fertnstert.2009.04.003
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发表时间：
2010-08-01
影响因子：
6.7
通讯作者：
Nardo, Luciano G.
中科院分区：
文献类型：
--
作者：
Gelbaya, Tarek A.;Tsoumpou, Ioanna;Nardo, Luciano G.
目的：确定选择性单胚胎移植（e-SET）政策是否在不影响活产率的情况下降低多胎出生率。设计：系统回顾和荟萃分析。设置：生殖医学三级转诊中心和IVF单位。患者：无。干预措施：科克伦对照试验注册库、随机对照试验（RCT）Meta注册库、EMBASE、MEDLINE、和SCISE 1974年至2008年，语言和出版年份不受限制。选择标准：比较e-SET与双胚胎移植（DET）在有或无卵胞浆内单精子注射（ICSI）的体外受精（IVF）后活产和多胎出生率的随机对照试验。非随机试验和研究，包括只有谁的患者有胚泡transfer.Main结果测量（S）：每例活产的可能性和多胎分娩的活产总数。其他结果包括种植率，妊娠率，流产和异位妊娠率，临床妊娠率，继续妊娠率每例患者，早产率每活产。结果：6个试验（n = 1354例）被纳入荟萃分析。与DET相比，e-SET政策显著降低了活产（RR 0.62; 95%CI，0.53-0.72）和多胎（RR 0.06; 95%CI，0.02-0.18）的概率。结论：卵裂期胚胎的选择性SET使活产和多胎的概率分别降低了38%和94%。来自随机对照试验的证据表明，增加e-SET尝试次数（新鲜和/或冷冻）的累积活产率与DET相似。为低生育力妇女提供三个周期的试管婴儿将对e-SET政策的采纳产生重大影响。（Fertil Steril（R）2010; 94：936-45. (c)美国生殖医学会（American Society for Reproductive Medicine）
Objective: To determine whether a policy of elective single-embryo transfer (e-SET) lowers the multiple birth rate without compromising the live birth rate.Design: Systematic review and meta-analysis.Setting: Tertiary referral center for reproductive medicine and IVF unit.Patient(s): None.Intervention(s): Searches of the Cochrane Controlled Trials Register, Meta-register for Randomized Controlled Trials (RCTs), EMBASE, MEDLINE, and SCISEARCH with no limitation on language and publication year, 1974 to 2008. Selection criteria: randomized, controlled trials comparing e-SET with double- embryo transfer (DET) for live birth and multiple birth rates after in vitro fertilization (IVF) with or without intracytoplasmic sperm injection (ICSI). Nonrandomized trials and studies that included only patients who had blastocyst transfer were excluded.Main Outcome Measure(s): The likelihood of live birth per patient and multiple birth per total number of live births. Other outcomes included implantation rate, pregnancy rate, miscarriage and ectopic pregnancy rates, clinical pregnancy rate, ongoing pregnancy rate per patient, and preterm delivery rate per live birth.Result(s): Six trials (n = 1354 patients) were included in the meta-analysis. Compared with DET, the e-SET policy was associated with a statistically significant reduction in the probability of live birth (RR 0.62; 95% CI, 0.53-0.72) and multiple birth (RR 0.06; 95% CI, 0.02-0.18).Conclusion(s): Elective-SET of embryos at the cleavage stage reduces the likelihood of live birth by 38% and multiple birth by 94%. Evidence from randomized, controlled trials suggests that increasing the number of e-SET attempts (fresh and/or frozen) results in a cumulative live birth rate similar to that of DET. Offering subfertile women three cycles of IVF will have a major impact on the uptake of an e-SET policy. (Fertil Steril (R) 2010; 94: 936-45. (c) 2010 by American Society for Reproductive Medicine.)