卵裂期和囊胚期胚胎移植妊娠结局的Meta分析

Meta analysis of pregnancy outcomes in embryo transfer at cleavage and blastocyst stages

目的系统评价卵裂期和囊胚期胚胎移植的妊娠结局。方法计算机检索PubMed、Embase、Medline和Cochrane library等外文数据库以及维普、中国生物医学文献数据库(CMB)、中国知网和万方数据库等国内数据库,自建库至2019年5月的所有文献,并通过人工阅读检索参考文献以及应用谷歌学术(Google Scholar)辅以检索,以避免文献漏检。2位研究者根据纳入及排除标准独立对文献进行筛选、资料提取和质量评价后,采用RevMan 5.3软件进行Meta分析。结果共纳入21个随机对照试验(RCT),共3887个病例。与卵裂期胚胎移植比较,囊胚期胚胎移植可获得显著升高的临床妊娠率[RR=1.12,95%CI(1.04,1.20),P=0.002],而活产率[RR=1.14,95%CI(0.95,1.38),P=0.16]和多胎妊娠率[RR=1.09,95%CI(0.90,1.33),P=0.37]无显著性差异。囊胚期胚胎移植的周期取消率显著高于卵裂期胚胎移植[RR=2.52,95%CI(1.84,3.45),P<0.00001]。亚组分析结果显示,患者预测指标和胚胎移植数量对临床妊娠率无显著影响(P>0.05)。结论囊胚期胚胎移植的临床妊娠率、周期取消率显著高于卵裂期胚胎移植,但活产率和多胎妊娠率与卵裂期胚胎移植无显著差异,患者预测指标和胚胎移植数目对临床妊娠率并无明显影响。受纳入研究数量和质量的限制,上述结论尚待开展更多高质量研究予以验证。

Objective:To systematically evaluate the pregnancy outcomes of embryo transfer at cleavage and blastocyst stages by Meta analysis.Methods:Foreign databases including PubMed,Embase,Medline and Cochrane library as well as domestic databases including VIP,CBM,CNKI and Wanfang database were searched with computer.All literatures published up to May 2019 were searched by manual reading and reference as well as supplemented by Google Scholar to avoid missing literature inspection.Two researchers conducted independent literature screening,data extraction and quality evaluation based on inclusion and exclusion criteria,and then Meta analysis was conducted with RevMan 5.3.Results:A total of 3887 cases of 21 Randomized controlled trials(RCTs)were included.Compared with cleavage embryo transfer,the blastocyst transfer can obtain significantly higher clinical pregnancy rate(RR=1.12,95%CI(1.04,1.20),P=0.002).There were no significant differences in live birth rate[RR=1.14,95%CI(0.95,1.38),P=0.16]and multiple pregnancy rate[RR=1.09,95%CI(0.90,1.33),P=0.37].The cycle cancellation rate in the blastocyst transfer was significantly higher than the cleavage embryo transfer[RR=2.52,95%CI(1.84,3.45),P<0.00001].The subgroup analysis shows that the prognosis indexes of patient and number of embryo transplantation had no significant effects on the clinical pregnancy rate(P>0.05).Conclusions:The clinical pregnancy rate and cycle cancellation rate of blastocyst transfer were significantly higher than that in cleavage embryo transfer,but the differences of live birth rate and multiple pregnancy rate were not significant.The prognosis indexes and number of embryo transplantation have no significant effect on the clinical pregnancy rate.Limited by the quantity and quality of the studies included,the above conclusions need to be verified by more high-quality studies.