移植前宫腔灌注人绒毛膜促性腺激素对于体外受精-胚胎移植妊娠结局影响的Meta分析

Effect of intrauterine infusion of human chorionic gonadotropin before embryo transfer on pregnancy outcomes in in vitro fertilization: a Meta-analysis

目的评价移植前宫腔灌注人绒毛膜促性腺激素(hCG)是否能影响体外受精-胚胎移植(IVF-ET)患者的妊娠结局。方法计算机检索Pub Med、EMBase、ISI Web of Science、Cochrane Library、中国知网全文数据库(CNKI)、中国生物医学文献数据库(CBM)、万方和维普等数据库,查找关于宫腔灌注hCG对于妊娠结局的影响的研究,检索年限自建库至2017年7月,对检索到的文献按照纳入和排除标准进行筛选、质量评价和数据提取,采用RevMan5.3软件进行数据分析。结果共纳入符合要求的12个随机对照研究,灌注组与对照组相比,临床妊娠率(OR=1.24,95%CI=1.08~1.43)和种植率(OR=1.21,95%CI=1.00~1.46)组间差异有统计学意义,活产率(OR=1.05,95%CI=0.81~1.36)和流产率(OR=1.02,95%CI=0.78~1.34)组间差异有统计学意义。其中移植卵裂期胚胎的患者,移植前宫腔灌注≥500 IU的hCG,与对照组相比,种植率(OR=1.61,95%CI=1.32~1.97)、临床妊娠率(OR=1.46,95%CI=1.26~1.70)和活产率(OR=1.52,95%CI=1.27~1.84)差异具有统计学意义。结论移植前宫腔灌注hCG能够改善不孕症患者胚胎移植的妊娠结局。

Objective To determine whether intrauterine human chorionic gonadotropin（hCG） infusion before embryo transfer impacts the in vitro fertilization-embryo transfer（IVF-ET） pregnancy outcomes. Methods Databases included Pub Med, EMBase, ISI Web of Science Cochrane Library, CNKI, Wanfang and VIP were searched for the study of the effect of hCG on pregnancy outcome. The retrieval period was from the date of database construction to July 2017. The literature screening according to the inclusion and exclusion criteria, followed by quality evaluation and data extraction. The Rev Man 5.3.5 software was used for data analysis. Results Twelve randomized controlled trials were analyzed. The results showed that there was a significant increase in clinical pregnancy rates（OR=1.24, 95% CI=1.08-1.43） and implantation rate（OR=1.21, 95% CI=1.00-1.46） in intrauterine hCG group compared with control group, but no significant difference in live birth rate（OR=1.05, 95% CI=0.81-1.36） and abortion rate（OR=1.02, 95% CI=0.78-1.34）. Subgroup analysis showed that, for the patients who received the intrauterine hCG ≥ 500 IU before cleavage stage embryo transfer, the implantation rate（OR=1.61, 95% CI=1.32-1.97）, the clinical pregnancy rates（OR=1.46, 95% CI=1.26-1.70） and the live birth rate（OR=1.52, 95% CI=1.27-1.84） were greater than those in controls. Conclusion The intrauterine perfusion of hCG can improve pregnancy outcomes of patients with embryo transfer.