短时受精与常规受精在体外受精周期效果的Meta分析

Effects of Short-term Fertilization versus Conventional Fertilization in Vitro Fertilization Cycles:A Meta-Analysis

目的系统评价体外受精-胚胎移植(IVF-ET)治疗中短时受精与常规受精两种受精方式的临床效果。方法计算机检索Pub Med、h e Cochrane Library(2014年第8期)、EMbase、CBM、CNKI、Wan Fang Data和VIP,搜集IVF治疗中短时受精与常规受精疗效比较的随机对照试验(RCT),检索时限均为从建库至2014年8月。由2位评价者按照纳入与排除标准独立筛选文献、提取资料和评价纳入研究的方法学质量,然后采用Rev Man 5.2软件进行Meta分析。结果最终纳入6个RCT,共计1 373例患者。Meta分析结果显示:短时受精在提高优质胚胎率[OR=1.42,95%CI(1.18,1.70),P=0.000 2]和临床妊娠率方面[OR=1.67,95%CI(1.33,2.09),P<0.000 01]优于常规受精,但两组的受精率、多精受精率和流产率无明显差异。结论现有证据显示,短时受精在提高优质胚胎率及临床妊娠率方面优于常规受精。受纳入研究数量及质量限制,上述结论尚需开展更多大样本、高质量、长期随访的RCT来加以验证。

Objective To systematically review the clinical effects of short-term and conventional fertilization for vitro fertilization-embryo transfer（IVF-ET）. Methods Randomized controlled trials（RCTs） about the clinical effects of short-term fertilization versus conventional fertilization for IVF-ET were searched in Pub Med,the Cochrane Library（Issue 8,2014）,CBM,CNKI,Wan Fang Data and VIP from inception to August 2014. Two reviewers independently screened literature according to the inclusion and exclusion criteria,extracted data,and assessed methodological quality of included studies. Then meta-analysis was performed using Rev Man 5.2 software. Results A total of six RCTs involving 1 373 patients were finally included. the results of meta-analysis indicated that： short-term fertilization was superior to conventional fertilization in increasing high quality embryo rates（OR=1.42,95%CI 1.18 to 1.70,P=0.000 2） as well as clinical pregnancy rates（OR=1.67,95%CI 1.33 to 2.09,P0.000 01）. However,the two groups were alike in fertilization rates,polyspermy rates,and miscarriage rates. Conclusion Current evidence indicates that short-term fertilization is superior to conventional fertilization in increasing high quality embryo rates as well as clinical pregnancy rates. Due to limited quality and quantity of the included studies,the above conclusion should be verified by conducting more large-scale,high quality RCTs with long-term follow-up.