自然周期与促排卵周期联合宫腔内人工授精临床疗效的meta分析

Effectiveness of Natural cycle and ovulation induction Cycle in Intrauterine Insemination: A Meta Analysis

目的系统评价自然周期和促排卵周期联合宫腔内人工授精(intrauterine insemination,IUI)对不孕患者治疗的有效性,旨在更合理有效的指导临床治疗。方法计算机检索2000年1月至2013年6月中国生物医学文献数据库(CBMDisc)、万方数据库、中国学术期刊网专题全文数据库(CNKI)、维普数据库、Pubmed、外文生物医学期刊文献数据(FMJS)中自然周期和促排卵周期联合IUI治疗不孕患者的随机对照试验(RCT)或临床对照试验。由2位评价员根据纳入与排除标准独立进行文献筛选、资料提取和质量评价后,采用Rev Man 5.0软件进行Meta分析。结果最终纳入9个研究,共8814个周期。Meta分析结果显示:对行IUI的不孕症患者,促排卵周期组与自然周期组相比,妊娠率[OR=1.47,95%CI(1.26,1.72),P<0.00001]、流产率[OR=2.49,95%CI(1.49,4.16),P=0.0005]、多胎率[OR=6.94,95%CI(1.94,24.83),P=0.003]均大于自然周期组,且差异有统计学意义;OHSS发生率[OR=4.17,95%CI(0.74,23.49),P=0.11]和宫外孕发生率[OR=2.22,95%CI(0.92,5.37),P=0.08]无明显差异。结论对自然周期和促排卵周期联合IUI治疗不孕患者的有效性而言,促排卵周期组能更好的改善其妊娠率,但其流产率和多胎率的发生较高,因此促排卵方案用于IUI时,其疗效及安全性需要进行更多的临床研究。由于纳入文献存在质量和数量不足以及方法学差异,本研究结论仅作为临床分析的参考,尚需后效评价和不断更新。

Objective：To evaluate the effectiveness of natural cycle and ovulation induction in intrauterine insemination,aimed at a more reasonable application of ovulation effectively to guide the clinical treatment.Methods：We searched CBMdisc,Wanfang,CNKI,VIP,Pub Med,FMJS to identify randomized controlled trails（RCTs）or clinical controlled trails on the comparison between natural cycle and ovulation induction cycle of intrauterine insemination in infertile patients,The duration of search was from January 2000 to June 2013.The included quality was evaluated by two evaluators. For the homogeneous studies we performed meta analysis. The extracted data were analyzed by Ren Man 5.0.Results：Nine literatures with 8814 cycles were selected for meta analysis based on our including standards. Meta analysis showed that compared with natural cycle group,pregnancy rates[OR=1.47,95%CI（1.26,1.72）,P0.00001],abortion rates[OR=2.49,95%CI（1.49,4.16）,P=0.0005],multiple pregnancy rate[OR=6.94,95%CI（1.94,24.83）,P=0.003] in ovulation induction cycle group were higher,the differences were statistically significant. There were no significant difference in the incidence of ectopic pregnancy[OR=2.22,95%CI（0.92,5.37）,P=0.08] and OHSS[OR=4.17,95%CI（0.74,23.49）,P=0.11] between two groups. Conclusion：In infertile patients with IUI treatment,compared with natural cycle group,ovulation induction cycle group can increase the pregnancy rate,but the abortion rates and multiple pregnancy rate also increase,so For these,ovulation induction cycle′s curative effect and security need to be more clinical research. Due to lack of quality and quantity in literature as well as the methodological differences,the conclusion of this research is only as the reference of clinical analysis and still need to reevaluation and constantly updated.