Edi-Osagie Edmond, Hooper Lee, Seif Mourad W
Academic Unit of Obstetrics, Gynaecology and Reproductive Healthcare, St Mary's Hospital, Manchester, UK.
Hum Reprod. 2003 Sep;18(9):1828-35. doi: 10.1093/humrep/deg334.
During the past decade in the UK, only one in six cycles of assisted conception has resulted successfully in a live birth. Assisted hatching (AH) has been proposed to improve outcome. This systematic review of randomized controlled trials addresses primary outcomes of live birth, clinical pregnancy and embryo implantation.
Trials on post-fertilization disruption of the zona pellucida were identified from the Cochrane Controlled Trials Register, MEDLINE, EMBASE and published bibliographies. Outcomes were analysed using random effects meta-analysis, sensitivity analysis, sub-grouping and meta-regression.
Of 23 included trials recruiting 2572 women, only six reported live birth data. AH had no significant effect on live birth (OR 1.21, 95% CI 0.82-1.78). There was a significant benefit of AH on clinical pregnancy (OR 1.63, 95% CI 1.27-2.09), especially in the sub-group of women with previous failure of assisted conception (OR 2.33, 95% CI 1.63-3.34). Meta-regression suggested that AH might be more useful in older women. Implantation data were not considered valid for statistical analysis. The methodological quality of included trials was sub-optimal.
AH probably enhances clinical pregnancy, especially in women with previous failure of assisted conception treatment and in older women; however, trials were of poor quality and so may be biased. Better quality trials reporting live birth are required to confirm any positive effects on the 'take-home-baby rate'.
在过去十年的英国，每六次辅助受孕周期中只有一次成功实现活产。有人提出辅助孵化（AH）可改善受孕结果。这项对随机对照试验的系统评价探讨了活产、临床妊娠和胚胎着床等主要结果。
从Cochrane对照试验注册库、MEDLINE、EMBASE及已发表的参考文献中识别关于受精后透明带破裂的试验。使用随机效应荟萃分析、敏感性分析、亚组分析和荟萃回归分析结果。
在纳入的23项试验中，共招募了2572名女性，只有6项报告了活产数据。辅助孵化对活产没有显著影响（比值比1.21，95%置信区间0.82 - 1.78）。辅助孵化对临床妊娠有显著益处（比值比1.63，95%置信区间1.27 - 2.09），尤其是在既往辅助受孕失败的女性亚组中（比值比2.33，95%置信区间1.63 - 3.34）。荟萃回归分析表明辅助孵化可能对年龄较大的女性更有用。着床数据被认为不适用于统计分析。纳入试验的方法学质量欠佳。
辅助孵化可能会提高临床妊娠率，尤其是在既往辅助受孕治疗失败的女性和年龄较大的女性中；然而，试验质量较差，可能存在偏差。需要开展质量更高的报告活产情况的试验，以确认对“抱婴回家率”的任何积极影响。
