Pandian Zabeena, Bhattacharya Siladitya, Nikolaou Dimitrios, Vale Luke, Templeton Allan
Department of Obstetrics & Gynaecology, Aberdeen Maternity Hospital and Health Services Research Unit, University of Aberdeen, Aberdeen AB25 2ZD, UK.
Hum Reprod. 2003 Oct;18(10):2001-7. doi: 10.1093/humrep/deg332.
IVF is an accepted treatment for unexplained infertility. The objective of this review was to determine whether, for unexplained infertility, IVF improves the probability of live birth compared with: (i) expectant management; (ii) clomiphene citrate (CC); (iii) intrauterine insemination (IUI); (iv) IUI with controlled ovarian stimulation; and (v) gamete intra-Fallopian transfer (GIFT).
This was based on a Cochrane review. Randomized controlled trials (RCTs) which compared the effectiveness of IVF with expectant management, CC, IUI with or without controlled ovarian stimulation and GIFT were included. Patients included couples with unexplained infertility. Live birth rate per woman/couple was the main outcome measure.
Nine RCT were identified. Five RCTs were included in the final meta-analysis. There were no comparative data for CC and live birth rates for expectant management or GIFT. There was no significant difference in clinical pregnancy rates between IVF and expectant management. There was no evidence of a difference in live birth rates between IVF and IUI either without (OR 1.96, 95% CI 0.88 to 4.36) or with (OR 1.15, 95% CI 0.55 to 2.42) ovarian stimulation. Clinical pregnancy rates with IVF were significantly higher compared with GIFT (OR 2.14, 95% CI 1.08 to 4.22) as were the multiple pregnancy rates (OR 6.25, 95% CI 1.70 to 23.00). Clinical heterogeneity was present among the studies. There was no evidence of statistical heterogeneity.
The effectiveness of IVF in unexplained infertility remains unproven. Larger trials with adequate power are warranted.
体外受精（IVF）是治疗不明原因不孕症的一种公认方法。本综述的目的是确定对于不明原因不孕症，与以下方法相比，IVF是否能提高活产概率：（i）期待治疗；（ii）枸橼酸氯米芬（CC）；（iii）宫腔内人工授精（IUI）；（iv）控制性卵巢刺激下的IUI；以及（v）配子输卵管内移植（GIFT）。
本研究基于Cochrane综述。纳入了比较IVF与期待治疗、CC、有无控制性卵巢刺激的IUI以及GIFT有效性的随机对照试验（RCT）。患者包括不明原因不孕症的夫妇。每位女性/夫妇的活产率是主要结局指标。
共识别出9项RCT。最终的荟萃分析纳入了5项RCT。没有关于CC以及期待治疗或GIFT的活产率的比较数据。IVF与期待治疗之间的临床妊娠率无显著差异。无论是在无（比值比[OR]1.96，95%置信区间[CI]0.88至4.36）还是有（OR 1.15，95% CI 0.55至2.42）卵巢刺激的情况下，IVF与IUI之间的活产率均无差异。IVF的临床妊娠率显著高于GIFT（OR 2.14，95% CI 1.08至4.22），多胎妊娠率也是如此（OR 6.25，95% CI 1.70至23.00）。各研究之间存在临床异质性。但无统计学异质性证据。
IVF治疗不明原因不孕症的有效性仍未得到证实。有必要开展更大规模且有足够效力的试验。
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