黄体酮肌肉注射与阴道缓释凝胶对IVF-ET结局影响的Meta分析

Effect of vaginal gel and intramuscular progesterone for luteal phase support in in vitro fertilization-embryo transfer: a Meta analysis

目的：评价黄体酮肌肉注射和阴道缓释凝胶（Crinone 8%）2种给药途径对体外受精-胚胎移植（IVF-ET）结局的影响。方法：计算机检索Pub Med、EMbase、Cochrane图书馆、中国知网和万方。收集2种给药途径的随机对照试验（RCT）,提取有效数据后采用Rev Man 5.1软件进行Meta分析。结果：纳入10个随机对照试验,共计2 528例患者,其中肌肉注射组1 331例,阴道缓释凝胶组1 197例。Meta分析结果显示：阴道缓释凝胶组和肌肉注射组的临床妊娠率（OR=0.93,95%CI=0.79-1.09,P=0.35）、继续妊娠率（OR=0.88,95%CI=0.64-1.21,P=0.43）、流产率（OR=0.75,95%CI=0.52-1.08,P=0.12）无统计学差异。结论：黄体酮肌肉注射和阴道缓释凝胶对IVF-ET后的临床妊娠率、继续妊娠率及流产率无显著影响。

Objective： To evaluate the effect of Crinone vaginal gel and intramuscular （IM） progesterone for luteal phase support （LPS） in in vitro fertilization-embryo transfer （IVF-ET） with respect to clinical outcomes. Methods： Papers from PubMed, EMbase, Cochrane library, CNKI and Wanfang data were electronically searched. Randomized controlled trials （RCT） were identified about vaginal gel and IM progesterone for LPS in IVF-ET. Date were extracted from these trials and analyzed by RevMan 5.1 software. Results： A total of 10 RCTs involving 2 528 cases were included, of which 1 331 cases were in Crinone 8% group while the other 1 197 cases were in IM group. Meta analysis showed a comparable effect between vaginal gel and IM progesterone on the end points of clinical pregnancy rate （OR=0.93, 95%CI=0.79-1.09, P=0.35）, ongoing pregnancy rate （OR=0.88, 95%CI=0.64- 1.21, P=0.43） and miscarriage rate （OR=0.75, 95%CI=0.52-1.08, P=0.12）. Conclusion： There is no significant difference between vaginal gel and im progesterone in terms of clinical pregnancy rate, ongoing pregnancy rate and miscarriage rate.