不同促排卵方案对卵巢低反应者行IVF-ET临床效果的Meta分析

Meta-analysis of clinical effects of different ovulation induction protocols on IVF-ET outcome in patients with poor ovarian response

目的 系统评价不同促排卵方案在高龄卵巢低反应者(POR)行IVF-ET的临床效果。 方法 通过计算机全面检索数据库,其中主要包括中国生物医学文献(CBM)、中国知网(CNKI)、维普(VIP)、万方等中文数据库以及PubMed、CochraneLibrary、EMbase等英文数据库,检索时限为建库至2019年1月,检索不同促排卵方案在IVF-ET中对卵巢低反应者的临床效果研究。由2位研究者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。采用Cochrane协作网提供的RevMan5.3统计软件进行Meta分析。 结果 经过严格筛选最终纳入的9篇文献,共计1982例POR患者。Meta分析结果显示:常规促排卵方案与微刺激方案比较,周期临床妊娠率、流产率、受精率等方面无显著性差异(P>0.05);常规促排卵方案的周期移植取消率显著低于微刺激方案(P<0.05)。 结论 目前没有证据证实微刺激方案在高龄卵巢低反应女性中可以改善临床结局。

Objective : To systematically evaluate the clinical effects of different ovulation induction protocols on IVF-ET outcome in elderly patients with poor ovarian response(POR). Methods : The databases were comprehensively searched for the clinical effects of different ovulation induction protocols on IVE-ET outcome in POR patients by computer,including Chinese databases such as CBM,CNKI,VIP,Wanfang,etc.and English databases such as PubMed,Cochrane Library,EMbase,etc.from the time of database establishment until January 2019. Two evaluators independently performed literature screening,data extraction and quality assessment based on inclusion and exclusion criteria.Meta-analysis was performed using RevMan 5.3 statistical software provided by the Cochrane Collaboration Network. Results : Nine papers were eventually included after rigorous screening,totaling 1 982 patients with POR.The results of meta-analysis showed that there were no significant differences in the clinical pregnancy rate per cycle,abortion rate and fertilization rate between the conventional ovulation induction protocol and the micro-stimulation protocol( P >0.05).The cycle transplant cancellation rate of the conventional ovulation induction protocol was significantly lower than that of the micro-stimulation protocol( P <0.05). Conclusions : There is currently no evidence to prove that the micro-stimulation protocol can improve clinical outcomes in elderly women with poor ovarian response.