选择性单个卵裂期胚胎移植可行性的Meta分析

Feasibility of Elective Single Cleavage-Stage Embryo Transfer: A Meta-Analysis

目的为给单胚胎移植的临床应用提供更可靠的证据,对国内外公开发表的选择性单个与两个卵裂期胚胎移植的临床研究进行Meta分析。方法计算机检索PubMed、Ovid、EMbase、MEDLINE、CENTRAL等中外生物医学数据库,收集有关选择性单个与两个卵裂期胚胎移植的随机对照试验(RCT)。按Cochrane系统评价方法,由两位研究者独立选择文献、提取资料并评价纳入研究的方法学质量后,采用RevMan 5.1软件进行Meta分析。结果共纳入9个RCT,共计2 784例患者,其中试验组1 452例,对照组1 332例。Meta分析结果显示:与两个卵裂期胚胎移植比较,选择性单个卵裂期胚胎移植降低了每个移植周期的活产率[RR=0.66,95%CI(0.59,0.73),P<0.000 01],显著降低了多胎妊娠率[RR=0.05,95%CI(0.02,0.11),P<0.000 01],亦降低了早产儿发生率[RR=0.39,95%CI(0.26,0.60),P<0.000 1]和低体重儿发生率[RR=0.25,95%CI(0.15,0.44),P<0.000 01],但对异位妊娠率[RR=0.55,95%CI(0.11,2.77),P=0.47]、流产率[RR=1.33,95%CI(0.92,1.91),P=0.13]和围产儿死亡率[RR=0.31,95%CI(0.03,2.76),P=0.29]无影响。结论与两个胚胎移植相比,选择性单胚胎移植降低了每移植周期临床妊娠率、多胎妊娠率、早产儿发生率及低体重儿发生率,在其他指标方面两组无显著差异。

Objective To analyze published literature about the clinical studies on elective single versus double embryo transfer using meta-analysis, so as to provide more convincing evidence for the clinical application of elective single embryo transfer. Methods We electronically searched foreign and domestic biomedical databases including PubMed, Ovid, EMbase, MEDLINE and CENTRAL, to collect randomized controlled trials （RCTs） on elective single versus double embryo transfer. According to Cochrane systematic review method, two reviewers independently screened studies according to inclusion and exclusion criteria, extracted data, and assessed methodological quality of the included studies. Then, meta-analysis was performed using RevMan 5.1 software. Results A total of 9 RCTs involving 2 784 cases were included, of which, 1 452 were in the trial group while the other 1 332 were in the control group. The results of meta-analysis indicated that, compared with elective double embryo transfer, during each transfer period elective single embryo transfer reduced the live birth rate （RR=0.66, 95%CI 0.59 to 0.73, P〈0.000 01）, multiple pregnancy rate （RR=0.05 95%CI 0.02 to 0.11, P〈0.000 01）, preterm birth rate （RR=0.39, 95%CI 0.26 to 0.60, P〈0.000 1）, and low birth weight rate （RR=0.25, 95%CI 0.15 to 0.44, P〈0.000 01）. However, it had no effect on the ectopic pregnancy rate （RR=0.55, 95%CI 0.11 to 2.77, P=0.47）, miscarriage rate （RR=1.33, 95%CI 0.92 to 1.91, P=0.13）, and neonatal mortality rate （RR=0.31, 95%CI 0.03 to 2.76, P=0.29）. Conclusion Compared with elective double embryo transfer, during each transfer period elective single embryo transfer reduces the live birth rate, multiple pregnancy rate, preterm birth rate, and low birth weight rate. No significant difference was found between the two groups in the other indicators.