IVF/ICSI术后孕激素黄体支持最佳终止时间的Meta分析

The Optimal Duration of Progesterone Supplementation after IVF/ICSI:a Meta-analysis

目的：系统评价体外受精／单精子卵泡浆内显微注射（IVF／ICSI）术后孕激素黄体支持的不同终止时间对妊娠结局的影响。方法：检索MEDLINE、EMBASE、CENTRAL、中国生物医学数据库和万方数据库，检索时间截止2012年7月。纳入关于IVF／ICSI术后早期停用孕激素和持续使用孕激素的所有随机对照试验，质量评价后采用RevMan5．1软件进行Meta分析。结果：共纳入6个随机对照试验，1201例患者，IVF／ICSI术后妊娠的妇女接受早期停用孕激素组和持续孕激素治疗组在活产率（RR=0．95，95％C10．86～1．05）、流产率（RR=1．01，95％C10．74～1．38）和持续妊娠率（RR=0．97，95％C10．90～1．05）上差异均无统计学意义（P〉0．1）；敏感性分析前后结果保持稳定。结论：目前最佳证据表明IVF／ICSI治疗后妊娠的妇女在尿妊娠实验阳性后常规使用孕激素支持黄体可能是没有必要的，但上述结论尚需大样本的随机对照试验来进一步验证。

Objective：To investigate the effects of progesterone supplementation duration on pregnancy outcomes after in vitro fertilisation/intracytoplasmic sperm injection （IVF/ICSI）. Methods： We searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials （ CENTRALS）, the Chinese bio- medicine （CBM） literature database, and the Wanfang database. All available randomised controlled trials （RCT） that compared the effects of progesterone cessation with progesterone continuation during early preg- nancy after IVF/ICSI were included and evaluated. RevMan 5. 1 software was used to do a Meta-analysis. Results：Six eligible studies with a total of 1201 randomised participants were included in this analysis. No statistically significant differences were detected between patients who underwent early progesterone cessa- tion and those who received progesterone continuation for luteal phase support in terms of live birth rate （RR= 0.95, 95% CI0.86 - 1.05）, miscarriage rate （RR=1.01, 95% CI0.74 - 1.38） or ongoing pregnancy rate （ RR = 0.97, 95% CI 0.90 - 1.05）. These results did not change after a sensitivity analysis. Conclusions.The currently available evidence suggests that progesterone supplementation beyond the first positive HCG test after IVF/ICSI might generally be unnecessary, although large-scale randomised con- trolled trials are needed to strengthen this conclusion.