ObjectivesTo systematically review the efficacy and safety of local endometrial mechanical stimulation in patients with recurrent embryo implantation failure in vitro fertilization.MethodsPubMed, 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.ResultsA total of 10 studies, including 8 randomized controlled trials and 2 case-control studies, and involving 1 274 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 to 1.35, P=0.63).ConclusionCurrent 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.
【摘要】 目的 探討各種不同體外受精（IVF）助孕方案對子宮腺肌病伴不孕癥患者的療效。 方法 對2006年1月-2009年6月進行IVF助孕治療的子宮腺肌病伴不孕癥患者63例的臨床資料進行回顧性分析。根據是否應用長效促性腺激素釋放激素激動劑（GnRH-a）及啟動促性腺激素（Gn）時間分為超長方案、長效GnRH-a后長或短方案、常規長方案3組，對IVF助孕療效進行分析。 結果 3種治療方案的Gn刺激天數、Gn總量、獲卵數、不良反應發生率和流產率比較無統計學意義（Pgt;0.05）；3種治療方案的周期取消率為20.0%、7.7%、30.0%，比較有統計學意義（χ2=5.74，Plt;0.05），方案2的周期取消率低于方案1和方案3，有統計學意義（χ2=7.21，Plt;0.05）；3種治療方案的繼續妊娠率為23.0%、37.0%、15.3%，有統計學意義（χ2=11.31，Plt;0.05），方案2的繼續妊娠率高于方案1和方案3，有統計學意義（χ2=8.52，Plt;0.05）。 結論 與超長方案和常規長方案相比，子宮腺肌病伴不孕癥患者采用長效GnRH-a治療后長方案或短方案行IVF助孕治療，妊娠率升高，周期取消率降低。【Abstract】 Objective To investigate the effect of different in vitro fertilization (IVF) treatment protocols on infertile women with adenomyosis. Methods Sixty-four infertile women with adenomyosis who had IVF treatment cycles from January 2006 to June 2009 were retrospectively analyzed. According to administration of long course gonadotropin-releasing hormone agonist (GnRH-a) and the start time of gonadotropin (Gn), all participants were divided into three groups: the first group with ultra-long term protocol, the second group with long or short term protocol after administration of long course GnRH-a and the third group with routine long term protocol. Results There were no differences among the three groups with regard to days of Gn administration, amounts of Gn administration, numbers of retrieved oocytes, prevalence of poor response and miscarriage (Pgt;0.05). The cancelation rates of the three groups were 20.0%、7.7% and 30.0% respectively. There were significant differences in cancelation rates among the groups (χ2=5.74, Plt;0.05), and the cancelation rate in the second group was significantly lower than the other groups (χ2=7.21, Plt;0.05). The ongoing pregnancy rates of the groups were 23.0%、37.0% and 15.3% respectively. There were significant differences in ongoing pregnancy rates among three groups (χ2=11.31, Plt;0.05), and the ongoing pregnancy rate in the second group was significantly higher than the other groups (χ2=8.52, Plt;0.05). Conclusion Compared with the ultra-long term and routine long term protocol of IVF treatment in infertile woman with adenomyosis, the ongoing pregnancy rate might be higher and the cancelation rate might be lower in the long or short term protocol after administration of long course GnRH-a.
Objective To analyze the efficacy and safety of different acupuncture methods on outcome of in vitro fertilization-embryo transfer (IVF-ET). Methods The PubMed, EMbase, Cochrane Library, CNKI, VIP, WanFang Data and CBM databases were searched to collect randomized controlled trials (RCTs) related to the objectives of the study from the inception to April 16, 2023. After two investigators independently screened the literature, extracted the data and evaluated the risk of bias of the included studies, a network meta-analysis was performed using Stata 16.0 software. Results There were 62 trials total with 9844 patients, involving 7 interventions. Network meta-findings analysis revealed the following: ① Clinical pregnancy rate (CPR): needle warming > auricular acupressure > transcutaneous electrical acupoint stimulation (TEAS) > electroacupuncture > acupuncture > sham acupuncture > no adjunctive treatment; ② Live birth rate (LBR): electroacupuncture > auricular acupressure > TEAS > acupuncture > sham acupuncture > no adjunctive treatment. Conclusion?Needle warming assisted IVF-ET is superior to other acupuncture therapies in improving CPR, especially during the promotion period of excretion, and the selection of Zusanli, Guanyuan and uterine acupoints for 3-month cycles may have the best effect. And for the LBR, the effect of electroacupuncture is better than that of other therapies. Besides, auricular acupressure may have good therapeutic potential. Due to the limited quality and quantity of the included studies, more high quality studies are required to verify the above conclusions.
【摘要】 目的 探討不同年齡段和不同內膜準備方法對凍融胚胎移植（FET）妊娠率的影響。 方法 回顧性分析2007年3月-2009年8月107例患者131個FET周期，比較不同年齡段、不同內膜準備方法的妊娠情況。 結果 ①lt;29歲、30～34歲、≥35歲患者的周期臨床妊娠率分別為45.28%、37.88%、33.33%，比較無統計學意義（Pgt;0.05）。②自然周期和激素替代周期內膜準備，兩種方法患者平均年齡、平均移植胚胎數、胚胎評分及胚胎細胞數比較無統計學意義（Pgt;0.05），但自然周期的胚胎種植率及周期臨床妊娠率均明顯低于激素替代周期（16.78%比29.21%；29.51%比50.00%），比較有統計學意義（Plt;0.05）。 結論 患者年齡不影響FET周期臨床妊娠率，激素替代周期內膜準備的FET胚胎種植率及周期臨床妊娠率明顯高于自然周期。【Abstract】 Objective To analyze the effect of age and method of preparing endometrium on the pregnancy rate of frozen-thawed embryo transfer (FET) among infertile women. Methods Retrospective analysis was made on 131 FET cycles in 107 patients from March 2007 to August 2009. The relationship between pregnancy rate of FET and following factors were analyzed: age, the method of preparing uterus endometrium. Results ①There was no significant difference in pregnancy rate of FET among ＜29, 30 - 34, and ≥35 years old patients (45.28%, 37.88%, and 33.33%, respectively) (Pgt;0.05). ②There was no significant difference in patients’ age, the average embryo amount, embryo score, the cell amount in every embryo between the FET with hormone replacement therapy (HRT) and the FET with natural cycle (NC). The embryo implantation rate and pregnancy rate of FET with NC were lower significantly than those of FET with HRT (16.78% vs 29.21%; 29.51% vs 50.00%) (P＜0.05). Conclusion Age might not influence pregnancy rate of FET. FET with HRT has higher implantation rate and pregnancy rate than FET with NC.
