Objective To evaluate the effectiveness and safety of aromatase inhibitors in ovulation induction for women with unexplained infertility. Methods The databases such as CNKI (1994 to June 2011), WanFang Data (1982 to June 2011), PubMed (1966 to June 2011) and The Cochrane Library (Issue 6, 2011) were searched to collect randomized controlled trials (RCTs) and quasi-randomized controlled trials (quasi-RCTs) for the comparison between aromatase inhibitors (AIs) and clomiphene citrate (CC). The quality of the retrieved trials was critically appraised and meta-analyses were conducted using RevMan 5.0.1 software. Results Nine studies were included; all of them were published in English. The results of meta-analyses showed there were no significant differences between AIs and CC in the pregnancy rate (RR=1.02, 95%CI 0.71 to 1.47), miscarriage rate (RR=1.00 95%CI 0.61 to 1.63), multiple pregnancy rate (RD= –0.02, 95%CI –0.07 to 0.03), and incidence rate of adverse events (RD=0.00, 95%CI –0.01 to 0.01); there were still no significant differences between the AIs+gonadotropin (Gn) group and the CC+Gn group in the pregnancy rate (RR=0.98, 95%CI 0.68 to 1.42), miscarriage rate (RR=1.23, 95%CI 0.70 to 2.15), multiple pregnancy rate (RD=0.00, 95%CI –0.10 to 0.10), and incidence rate of adverse events (RD=0.00, 95%CI –0.10 to 0.01). Conclusion Whether aromatase inhibitors can replace clomiphene citrate in ovulation induction for women with unexplained infertility is still an issue that has to be identified by performing well-designed large scale RCTs with longer follow-up duration.
ObjectiveTo systematically review the efficacy of acupuncture for PCOS infertility.MethodsPubMed, EMbase, The Cochrane Library, CNKI, WanFang Data, VIP and CBM databases were electronically searched to collect randomized controlled trials (RCTs) of acupuncture for PCOS infertility from inception to January 5th, 2020. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies. Meta-analysis was then performed using RevMan 5.3 software.ResultsA total of 28 RCTs involving 2 192 patients were included. The results of meta-analysis showed that compared with western medicine alone, acupuncture could increase the pregnancy rate (RR=1.80, 95%CI 1.45 to 2.23, P<0.000 01) and ovulation rate (RR=1.33, 95%CI 1.15 to 1.54, P=0.000 1), and reduce levels of LH (SMD=?0.62, 95%CI ?0.96 to ?0.28, P=0.000 4) and LH/FSH (SMD=?0.65, 95%CI ?1.02 to ?0.29, P=0.000 5). Acupuncture combined with western medicine could increase the pregnancy rate (RR=1.75, 95% CI 1.50 to 2.03, P<0.000 01) and ovulation rate (RR=1.29, 95%CI 1.18 to 1.41, P<0.000 01), decrease levels of LH (SMD=?1.09, 95%CI ?1.64 to ?0.53, P=0.000 1), LH/FSH (SMD=?1.30, 95%CI ?2.35 to ?0.25, P=0.02), and levels of T (SMD=?1.13, 95%CI ?1.59 to ?0.66, P<0.000 01).ConclusionsCurrent evidence shows that acupuncture alone or combined with western medicine can significantly improve ovulation rate, pregnancy rate and reduce hormone level. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify above conclusions.
【摘要】 目的 分析宮腔鏡聯合腹腔鏡在不孕癥診治中的應用和意義。 方法 回顧性分析2007年1月-2009年12月采用宮腔鏡聯合腹腔鏡手術診治92例女性不孕癥患者的臨床資料。 結果 92例中原發不孕39例，繼發不孕53例；其中有盆腔病變者86例，占93.5%。不孕原因居前四位分別是盆腔粘連31例（33.7%），輸卵管阻塞24例（26.1%），子宮內膜異位癥10例（10.9%），子宮內膜息肉8例（8.7%）。輸卵管阻塞24例行宮腔鏡引導下單極電凝器鈍性逆行分離術或造口術，有20例輸卵管復通，復通率66.7%。術后6~12個月年隨訪，妊娠率為19.6%（18/92），其中宮內妊娠15例，宮外孕3例。 結論 腹腔鏡聯合宮腔鏡檢查能快速準確地明確女性不孕的確切原因及部位，并可采取針對性治療措施，是目前診治不孕癥的可靠方法。【Abstract】 Objective To investigate the application and role of laparoscopy combined with hysteroscopy in the diagnosis and treatment of infertile patients. Methods Ninety-two patient with infertility who examined and treated with laparoscopy combined with hysteroscopy in this hospital were retrospectively analyzed from January 2007 to December 2009. Results There were 39 patients with primary infertility and 53 patients with secondary infertility.The main reason of infertility was pelvic diseases (93.5%). In the pelvic diseases,the common causes included pelvic adhesion (31 cases, 33.7%), obstruction of oviduct (24 cases, 26.1%), endometriosis (10 cases, 10.9%), and endometrial polyp (8 cases, 8.7%). Twenty-four patients with obstruction of oviduct were treated with hysteroscopy conducting unipolar electrocoagulation tool, 20 fallopian tubes were unobstructed. The recover rate was 66.7%. All the patients received follow-up by 6 - 12 months, and the pregnancy rate was 19.6% (18/92). Out of these 18 patients, 15 patients were intrauterine and 3 extrauterine. Conclusion Laparoscopy combined with hysteroscopy can find out the exact reasons of infertility and offer the respective treatment, and be a reliable method to diagnose and treat infertility patient.
Objective To investigate infertile inpatients hospitalized in Pingjin Hospital in Tianjin from 2008 to 2010, so as to provide baseline data for further research. Methods According to diagnosis criteria of WHO, we collected demographical characteristics, disease cause and cost constitution of infertility inpatients hospitalized in Pingjin Hospital in Tianjin from 2008 to 2010. The data of each patient were input into ACCESS database and SPSS 13.0 was used for statistical analysis. Results a) From 2008 to 2010, there were 1 452 infertile patients from 33 different areas of mainland China, 79.7% of which was from the north of China. b) The mean age was 31.2±4.3 years old. The percentage of patients aged 30 to 34 years accounted for the most (40.3%). Mental laborers (23.3%) were more than physical laborers (7.2%). 36.7% of patients received education from universities and 83.1% of patients had family income ranging from 20,000 yuan to 190,000 yuan. c) The mean age of the first sexual activity was 21.4±2.9 years old. 53.7% of patients had only one sexual partner and most couples had sexual activities twice every week. The mean age of husbands was 32.9±5.5 years old with the highest percentage of 30 to 35 years old (39.2%). The percent of intellectual work of husband was the highest (35.9%). 64.9% of patients had normal semen analysis results and 23.0% never took related examination. d) 29.9% of patients was primary infertility and 70.1% was secondary infertility, of which 57.6% had either induced or medical abortion. The mean duration of infertility was 5.2±3.5 years (range 1 to 21 year). e) 76.3% of infertile patients had pelvic adhesion and 88.6% suffered from tubal disease. Among the tubal infertile patients, 23.6% had uterine disease, 5.2% had ovarian disease, 5.0% had endometriosis, 6.7% had multiple problems, and 4.8% had unexplained infertility. In patients with tubal infertility, the incidence of distal fimbria atresia (45.8%) was higher than that of proximal block (32.9%). 24.7% of patients with fimbria atresia had hydrosalpinx and among of them, 21.1% had no hydrosalpinx. 15.2% had congenital tubal defects. f) The average hospital stay was 10.5 days and the cost was 14 253.3 yuan per person. The percentage of material cost was 29.1% and that of drugs was 18.2%. Conclusion a) The total number of infertile inpatients was 1 452 in gynecology department of Pingjin Hospital of Tianjin from 2008 to 2010. 79.7% of patient was from North China. Most of them were 30 to 34 years old and 44.3% had no job. The percentage of patients had university education and that of low-middle family income was the highest. Sexual activity was relatively traditional. Most husbands were 30 to 35 years old and intellectual workers, and 23.0% of them had never taken an examination of semen analysis. More patients were secondary infertile, and the duration of infertility was 1 to 21 years. b) 76.3% of patients had pelvic adhesion and 88.6% had tubal disease. The incidence of distal tubal fimbria atresia was higher than proximal tubal occlusion. c) The average hospital stay was 10.5 days and the cost was 14 253.3 yuan per person which was further lower than each cycle cost of assisted reproductive technology. The overall costs included materials and drugs (47.3%), which were mainly at patients’ own expense.
【摘要】 目的 觀察腹腔鏡手術聯合孕三烯酮治療子宮內膜異位癥合并不孕的療效及不同評分系統對妊娠結局的預測價值。 方法 回顧性分析2004年1月-2006年12月收治的97例子宮內膜異位癥合并不孕患者的臨床病理資料，統計其術后妊娠率及活產率。 結果 術后1年內與1~2年的妊娠率與活產率比較，差異均無統計學意義（Pgt;0.05）。根據美國生育協會1985年修訂的子宮內膜異位癥分期標準（r-AFS）進行分期，各期患者術后妊娠率差異無統計學意義（Pgt;0.05）；但隨著分期升高，活產率逐漸下降（Plt;0.05）。子宮內膜異位癥生育指數（EFI）評分越高，其妊娠率和活產率也越高（Plt;0.05）。 結論 子宮內膜異位癥患者腹腔鏡手術后聯用孕三烯酮可能會提高遠期妊娠率。r-AFS分期對妊娠結局的預測有一定局限性，而EFI具有較好的預測性。【Abstract】 Objective To evaluate the therapeutic effectiveness of laparoscopic surgery combined with gestrinone treatment in the infertile women with endometriosis (EM), and the value of different score systems to predict gestational outcome. Methods We retrospectively analyzed the clinical data of 97 infertile women with EM who were treated in our hospital from January 2004 to December 2006, and collected their pregnancy rate (PR) and live birth rate (LBR) after operation. Results There was no significant difference of PR and LBR within the 1st year and between the 1st and the 2nd year (Pgt;0.05). There was no significant difference of PR among women of various stages of EM based on the 1985 edition of risk stratification for patients with EM put forward by American Fertility Society (r-AFS) (Pgt;0.05), but the LBR decreased with the raising of the stages (Plt;0.05). The endometriosis fertility index (EFI) was positively correlated with PR and LBR (Plt;0.05). Conclusion Laparoscopic surgery combined with gestrinone may increase the long-term pregnancy rate of women with EM. R-AFS classification is limited in predicting the gestational outcome of women with EM, while EFI achieves a better result.
【摘要】 目的 探討絕經期促性腺激素及氯米芬在促排卵治療中適宜的治療方法。 方法 2004年8月〖CD3/5〗2008年5月對80例不孕患者實施促排卵治療。測定血雌激素、黃體生成素水平、陰道B型超聲、子宮頸黏液評分及基礎體溫測定監測排卵,并觀察不良反應的發生情況。 結果 使用氯米芬及絕經期促性腺激素排卵率分別為773%和856%；卵巢過度刺激綜合癥發生率為150%,大多由使用絕經期促性腺激素方案引起,且起始劑量150 U；未破裂卵泡黃素化綜合征的發生率為90%。 結論 絕經期促性腺激素和氯米芬治療排卵障礙性不孕有較好的療效,絕經期促性腺激素和氯米芬促排卵治療效果與卵巢的狀態及激素水平有關。促性腺激素的使用應強調個體化,以達到較好的治療效果并降低卵巢過度刺激綜合癥的發生。【Abstract】 Objective To explore the proper method with human menopausal gonadotropin and clomiphene in facilitating ovulation treatment. Methods Eighty infertility patients with the facilitating ovulation treatment were included from August 2004 to May 2008. Ovulation monitoring was based on the level of estrogen and luteinizing hormone, transvaginal B ultrasound, the cervical Inlser score and assay of basal body temperature. Besides, adverse reactions were observed. Results The rates of ovulation of clomiphene and human menopausal gonadotropin were 77.3% and 85.6%. The rate of ovarian hyperstimulation syndrome (OHSS), which was mostly caused by human menopausal gonadotropin with 150 IU, was 150%. The rate of luteinized unruptured follicle syndrome (LUFS) was 90%. Conclusion Individual therapy with human menopausal gonadotropin and clomiphene is essential to infertility patients with ovulation barrier. The efficacy of human menopausal gonadotropin and clomiphene is relevant to the ovarian condition and the hormone levels. Individual using of hormone is important in the facilitating ovulation treatment, which is helpful to increase the effective efficacy and prevent the OHSS.
Objective To systematically review the methodological quality of guidelines concerning infertility, so as to provide references for clinical practice. Methods Guidelines concerning infertility were electronically retrieved (from inception to Feb. 2013) in PubMed, EMbase, CBM, WanFang Data, CNKI, GIN guideline database guideline development websites (including NGC, NICE, SIGN, NZGG, SOGC, etc.), and medical associtation websites (including IFFS, FIGO, ESHRE, NFOG, RCOG, ASRM, ACOG, etc.). We also searched Chinese guideline websites including the website of the National Health and Family Planning Commission of People’s Republic of China, CGC (China Guideline Clearinghouse), and CPGN (Clinical Practice Guideline Net). Two reviews independently screened literature according to the inclusion and exclusion criteria, and assessed the quality of guideline development and reporting using the Appraisal of Guidelines for Research and Evaluation (AGREE II). Results a) A total of 16 guidelines concerning infertility were included, with development time ranging from 1998 to 2012. Among 16 guidelines, 10 guidelines were made by the USA, 3 by Britan, 1 by the Europe, and 1 by America and Europe. b) The scores of guidelines according to the domains of AGREE II decreased from “Clarity of presentations, scope and purpose”, “Participants”, “Applicability”, “Rigour of development”, and “Editorial independence”. 16 guidelines were generally low in quality. The levels of recommendations were Level A (5 guidelines), Level B (8 guidelines), and Level C (3 guidelines). c) Four evidence-based guidelines scored the top three in the domain of “Rigour of development”. d) The recommendations of different guidelines were fairly the same. e) No guidelines on infertility have been developed in China. Conclusion a) The guidelines on infertility should be improved in “Rigour of development” and “Applicability” in future. Conficts of interest should be addressed. b) Guidelines are recommended to be developed on the basis of the methods of evidence-based medicine, and best evidence is recommended. c) National organizations such as ASRM should be established in China, so as to develop biomedicine and TCM guidelines based on evidence and regulate the treatment. d) For the general assessment of guidelines, AGREE II should offer threshold criteria of suggestion.
