IVF-ET助孕中不同移植液对临床结局影响meta分析

The impact of different embryo transfer medium on the outcomes of in vitro fertilization-embryo transfer(IVF-ET):a meta-analysis

目的:系统评价在IVF-ET助孕过程中不同移植液应用对临床结局的影响。方法:通过电脑初检和手工检索相结合的方式,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、Cochrane Library、EMbase等英文数据库,检索时限为建库至2020年4月。由2名研究员根据纳入与排除标准独立进行文献筛选、资料提取和对文献进行质量评价,采用RevMan 5.3软件进行meta分析。结果:最终纳入21篇文献,共计10854例移植患者。IVF-ET助孕过程中,富含透明质酸的移植液(观察组)与以不含透明质酸的常规培养液为移植液(对照组)相比,流产率、分娩率、活产率和新生儿出生体重方面无差异(P>0.05);观察组可以增加临床妊娠率、种植率、多胎妊娠率,降低异位妊娠率(P<0.05);对不同的胚胎类型进行亚组分析,提高了新鲜卵裂期胚胎的临床妊娠率和种植率,同时提高冻融卵裂期胚胎的种植率,但对囊胚使用效果不显著。结论:富含透明质酸的移植液可以显著提高临床妊娠率、种植率、多胎妊娠率,降低异位妊娠率,尤其可提高新鲜周期卵裂期胚胎的妊娠结局。未增加流产率,对活产率及新生儿出生体重无影响。

Objective:To systematical assess the impact of different embryo transfer mediums on the outcomes of in vitro fertilization-embryo transfer(IVF-ET).Methods:Computer initial inspection combined with manual retrieval method was used to systematically retrieve the databases from built up to April 2020,such as PubMed,Embase,Cochrane Library,China Biology Medicine disc(CBM),China National Knowledge Infrastructure(CNKI),VIP,and Wanfangdata,etc.Two researchers independently conducted literature screening,data extraction and quality evaluation of the literature based on the inclusion and exclusion criteria.RevMan5.3 software was used for meta-analysis.Results:A total of 21 studies involving 10854 women after IVF-ET were included.The results showed that there was no significant difference in the rates of miscarriage,delivery,and live birth,and the neonatal birth weight between the women used embryo transfer mediums with hyaluronic acid-rich and the women used embryo transfer mediums without hyaluronic acid(P>0.05).The embryo transfer mediums with hyaluronic acid-rich could significantly increase the clinical pregnancy rate,planting rate,and multiple pregnancy rate,and could decrease ectopic pregnancy rate(P<0.05).Subgroup analysis was performed by different embryo types,the embryo transfer mediums with hyaluronic acid-rich could significantly increase the clinical pregnancy rate and planting rate of fresh cleavage stage embryos,and could also increase the planting rate of freeze-thaw cleavage stage embryos,while the effect was not significant for blastocysts.Conclusion:The embryo transfer mediums with hyaluronic acid-rich can significantly improve the clinical pregnancy rate,the implantation rate,the multiple pregnancy rate,reduce the rate of ectopic pregnancy,in particular,can improve the pregnancy outcomes of fresh cycle cleavage stage embryos,which will not increase the miscarriage rate,and will not affect the live birth rate and the neonatal birth weight.