内膜机械刺激在试管婴儿反复种植失败患者中有效性和安全性的系统评价

Efficacy and safety of local endometrial mechanical stimulation in patients with recurrent embryo implantation failure: a systematic review

目的系统评价内膜机械刺激在试管婴儿反复种植失败患者中应用的有效性和安全性。方法计算机检索PubMed、EMbase、The Cochrane Library、CNKI、WanFang Data和VIP数据库,搜集有关内膜机械刺激在试管婴儿反复种植失败患者中应用的临床对照研究,检索时限均为建库至2018年3月。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析。结果最终纳入10个研究,其中8个为随机对照试验,2个为前瞻性队列研究,包括1 274名患者。Meta分析结果显示:内膜机械刺激组的临床妊娠率高于对照组[RR=1.40,95%CI(1.04,1.89),P=0.03]。但两组在着床率[RR=0.75,95%CI(0.50,1.13),P=0.17]、活产率[RR=1.38,95%CI(0.99,1.93),P=0.06]、流产率[RR=0.83,95%CI(0.55,1.24),P=0.36]和多胎妊娠率[RR=0.90,95%CI(0.61,1.35),P=0.63]的差异均无统计学意义。结论当前证据显示,对于反复种植失败患者,再次移植前行子宫内膜机械刺激可能有助于提高试管婴儿的临床妊娠率,但对着床率、活产率、流产率、多胎妊娠率、异位妊娠率等均无明显影响。受纳入研究数量和质量的限制,上述结论尚待更多高质量研究予以验证。

Objectives To systematically review the efficacy and safety of local endometrial mechanical stimulation in patients with recurrent embryo implantation failure in vitro fertilization. Methods PubMed, EMbase, The Cochrane Library, CNKI, WanFang Data and VIP databases were electronically searched to collect clinical controlled studies on the efficacy and safety of local endometrial mechanical stimulation in patients with recurrent embryo implantation failure from inception to March 2018. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.3 software. Results A total of 10 studies, including 8 randomized controlled trials and 2 case-control studies, and involving 1274 patients were included. The results of meta-analysis showed that: the clinical pregnancy rate of endometrial mechanical stimulation group was higher than that of control group(RR=1.40,95%CI 1.04 to 1.89, P=0.03). However, no significant differences were found in implantation rate(RR=0.75,95%CI 0.50 to 1.13, P=0.17), live births rate(RR=1.38,95%CI 0.99 to 1.93,P=0.06), miscarriage rate(RR=0.83,95%CI 0.55 to 1.24, P=0.36) and rate of multiple pregnancy(RR=0.90,95%CI 0.61 to1.35, P=0.63). Conclusion Current evidence shows that, for patients with repeated implantation failure, mechanical endometrial stimulation before re-transplantation may help to improve the clinical pregnancy rate of test-tube infants,however, it has no significant effects on implantation rate, live birth rate, abortion rate, multiple pregnancy rate and ectopic pregnancy rate. Due to limited quality and quantity of the included studies, more high quality studies are needed required to verify above conclusions.