AIM:To appraise critically the published randomised controlled trials(RCTs)reporting on the effectiveness of using hyaluronic acid(HA)for sperm immobilisation and selection before intracytoplasmic sperm injection(ICSI...AIM:To appraise critically the published randomised controlled trials(RCTs)reporting on the effectiveness of using hyaluronic acid(HA)for sperm immobilisation and selection before intracytoplasmic sperm injection(ICSI).METHODS:Two authors used the PICO Method in order to perform a comprehensive literature search of the standard medical databases in June 2015.Data from the included studies was extracted independently by two authors using a predefined pro-forma.Review Manager(RevM an)was used to calculate the combined outcomes where multiple studies contributed with their results.Risk ratio(RR)with a 95%CI using the Mantel-Haenszel method was calculated for binary data variables.Heterogeneity was measured using the χ2 test and quantified using I2.In case of substantial heterogeneity(P < 0.10 for χ2 test or I2 > 50%)the combined outcome was calculated using the random effects model.The results from the meta-analysis were displayed as forest plots.The guideline of the Cochrane Collaboration was used to assess the risk of bias and it was illustrated as a risk of bias graph.RESULTS:The systematic literature search identified 166 different studies related to sperm immobilisation and selection for ICSI.Eleven RCTs involving 13719 oocyte intracytoplasmatic injections with sperm immobilised and selected using HA or polyvinylpyrrolidone(PVP)were included in this systematic review and metaanalysis.There was low heterogeneity among the included trials(χ2 = 16.86,df = 11,P = 0.11; I2 = 35%).There was no statistical difference between HA and PVP groups in terms of fertilisation rate(RR = 1.01; 95%CI:0.99-1.03; z = 0.75; P = 0.45),good embryos rate(RR = 1.01; 95%CI:0.96-1.06; z = 0.30; P = 0.76),live birth rate(RR = 1.15; 95%CI:0.86-1.54; z = 0.92; P = 0.36),clinical pregnancy rate(RR = 1.04; 95%CI:0.92-1.17; z = 0.62; P = 0.53)and implantation rate(RR = 1.17; 95%CI:0.94-1.46; z = 0.40; P = 0.16).The quality of most of the included studies was moderate to poor because of unclear randomisation technique,inadequate allocation concealment and blinding.CONCLUSION:This systematic review and metaanalysis provides evidence of similar efficiency between using HA or PVP for sperm immobilisation and selection before ICSI.展开更多
文摘AIM:To appraise critically the published randomised controlled trials(RCTs)reporting on the effectiveness of using hyaluronic acid(HA)for sperm immobilisation and selection before intracytoplasmic sperm injection(ICSI).METHODS:Two authors used the PICO Method in order to perform a comprehensive literature search of the standard medical databases in June 2015.Data from the included studies was extracted independently by two authors using a predefined pro-forma.Review Manager(RevM an)was used to calculate the combined outcomes where multiple studies contributed with their results.Risk ratio(RR)with a 95%CI using the Mantel-Haenszel method was calculated for binary data variables.Heterogeneity was measured using the χ2 test and quantified using I2.In case of substantial heterogeneity(P < 0.10 for χ2 test or I2 > 50%)the combined outcome was calculated using the random effects model.The results from the meta-analysis were displayed as forest plots.The guideline of the Cochrane Collaboration was used to assess the risk of bias and it was illustrated as a risk of bias graph.RESULTS:The systematic literature search identified 166 different studies related to sperm immobilisation and selection for ICSI.Eleven RCTs involving 13719 oocyte intracytoplasmatic injections with sperm immobilised and selected using HA or polyvinylpyrrolidone(PVP)were included in this systematic review and metaanalysis.There was low heterogeneity among the included trials(χ2 = 16.86,df = 11,P = 0.11; I2 = 35%).There was no statistical difference between HA and PVP groups in terms of fertilisation rate(RR = 1.01; 95%CI:0.99-1.03; z = 0.75; P = 0.45),good embryos rate(RR = 1.01; 95%CI:0.96-1.06; z = 0.30; P = 0.76),live birth rate(RR = 1.15; 95%CI:0.86-1.54; z = 0.92; P = 0.36),clinical pregnancy rate(RR = 1.04; 95%CI:0.92-1.17; z = 0.62; P = 0.53)and implantation rate(RR = 1.17; 95%CI:0.94-1.46; z = 0.40; P = 0.16).The quality of most of the included studies was moderate to poor because of unclear randomisation technique,inadequate allocation concealment and blinding.CONCLUSION:This systematic review and metaanalysis provides evidence of similar efficiency between using HA or PVP for sperm immobilisation and selection before ICSI.
