不引起宫腔变形或受压的子宫肌壁间肌瘤对体外受精或卵细胞浆内单精子注射结局影响

The effect of intramural leiomyoma with non-cavity-distorting on the outcome of IVF/ICSI treatment: a Meta-analysis

目的探讨不引起宫腔变形或受压的子宫肌壁间肌瘤对体外受精(in-vitro fertilization,IVF)或卵细胞浆内单精子注射(intracytoplasmic sperm injection,ICSI)结局的影响。方法采用Meta分析方法,计算机检索MEDLINE、PREMEDLINE、Cochrane Library、中国期刊全文数据库(CNKI)、万方数据库等,收集有关随机对照试验或半随机对照试验,由两位研究者独立进行文献筛选、资料提取和方法学质量评价后,采用Rev Man 5.2和Stata 12.0软件进行Meta分析和Egger’s检验。结果共纳入10个研究,Egger’s检验(P=0.093),说明不存在出版及相关偏倚。Meta分析结果显示,有不引起宫腔变形或受压的子宫肌壁间肌瘤者行IVF或ICSI助孕,活产率(RR=0.75,95% CI0.64～0.87)和临床妊娠率(RR=0.82,95%CI0.74～0.92),均低于无肌瘤者(P<0.05);而胚胎植入率(RR=0.95,95% CI0.75～1.19)、流产率(RR=1.38,95% CI0.97～1.96)与无肌瘤者相比差异均无统计学意义(P>0.05)。结论子宫肌壁间肌瘤即使不引起宫腔变形或受压也可能影响IVF或ICSI助孕患者活产率和临床妊娠率。

Objective To evaluate the effect of intramural leiomyoma with non-cavity-distorting on the outcome of IVF/ICSI treatment. Methods The databases such as MEDLINE, PREMEDLINE, Coehrane Library,CNKI,Wanfang database were searched to collect randomized controlled trials （RCTs） or quasi-randomized controlled trials （quasi-RCTs） for the comparison. The quality of the retrieved trials was critically appraised. Egger＇s test and meta-analyses were conducted using Rev Man 5.2 and Stata 12.0 software respectively. Results A total of 10 studies were included, all of them had a higher quality. Egger＇s test （P = 0.093）, showed there were no publication and related biases. The results of meta-analyses showed, compared with women without leiomyoma, women with non-cavity-distorting intramural leiomyoma had significant decrease （P〈0.05） in the live birth rate （RR = 0.75,95% CI 0.64 -0.87） and clinical pregnancy rate （RR = 0.82,95% CI 0.74 - 0.92）, there were no significant differences （ P 〉 0.05 ） between the two groups in the embryo transfer rate （ RR = 0.95,95% CI0.75-1.19） and abortion rate （RR = 1.38,95% CI0.97-1.96）.Conclusion Intramural leiomyoma with non-cavity-distorting may also affect live birth rate and clinical pregnancy rate of IVF/ICSI.