Abou-Setta Ahmed M, D'Angelo Arianna, Sallam Hassan N, Hart Roger J, Al-Inany Hesham G
University of Alberta Evidence-based Practice Centre (UA-EPC), Alberta Research Centre for Health Evidence (ARCHE), Aberhart Centre One, Room 8412, 11402 University Avenue, Edmonton, Edmonton, Canada, T6G 2J3.
Cochrane Database Syst Rev. 2009 Oct 7(4):CD006567. doi: 10.1002/14651858.CD006567.pub2.
Techniques for embryo transfer (ET) are being developed, optimized, and standardized to provide the best outcomes.This includes methods to reduce the risk of embryo loss following ET.
To systematically locate, analyse, and review the best available evidence regarding the effectiveness of post-ET techniques for women undergoing in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI).
We searched electronic databases; reference lists of primary studies, review articles, and relevant publications; and conference abstracts. No language restrictions were applied.
Screening and selection of 2436 possible trial citations were performed independently by two review authors. Four prospective, truly randomised trials met the inclusion criteria. The trials compared two competing post ET interventions or an intervention versus no treatment in women undergoing IVF and ICSI.
Two review authors independently collected data and assessed risk of bias using a standardized data extraction form. Individual outcome data were extracted to support an intention-to-treat analysis.
The primary outcome, live birth rate, was not reported in any of the included trials. The ongoing pregnancy rate was only available for one trial that compared immediate ambulation with 30 minute bed rest, with no evidence of an effect with bed rest (OR 1.00; 95% CI 0.54 to 1.85).Secondary outcomes were sporadically reported with the exception of clinical pregnancy rate, which was reported in all of the included trials. There was no significant difference between less bed rest and more rest (OR 1.13; 95% CI 0.77 to 1.67). Nor was there any significant difference between the use of a fibrin sealant and control (OR 0.98; 95% CI 0.54 to 1.78). Even so, there was a significantly higher probability of pregnancy following mechanical closure of the cervix compared with no intervention (OR 1.92; 95% CI 1.40 to 2.63).The risk of bias of the included studies was variable. The reporting of a proper method of randomisation and allocation concealment was demonstrated in the majority of trials, while only one trial was reported to be blinded.
AUTHORS' CONCLUSIONS: There is insufficient evidence to support a certain amount of time for women to remain recumbent following ET, or to support the use of fibrin sealants. Finally, there is limited evidence to support the use of mechanical closure of the cervical canal following ET. Further well-designed and powered studies are required to determine the true effect, if any, of these and other post ET techniques for women undergoing IVF and ICSI.
胚胎移植（ET）技术正在不断发展、优化和标准化，以实现最佳效果。这包括降低胚胎移植后胚胎丢失风险的方法。
系统地查找、分析和综述关于体外受精（IVF）和卵胞浆内单精子注射（ICSI）术后技术有效性的最佳现有证据。
我们检索了电子数据库；原始研究、综述文章和相关出版物的参考文献列表；以及会议摘要。未设语言限制。
两名综述作者独立对2436条可能的试验引文进行筛选和选择。四项前瞻性、真正随机试验符合纳入标准。这些试验比较了两种相互竞争的胚胎移植后干预措施，或对接受IVF和ICSI的女性进行干预与不进行治疗的效果。
两名综述作者独立收集数据，并使用标准化数据提取表评估偏倚风险。提取个体结局数据以支持意向性分析。
纳入的任何试验均未报告主要结局即活产率。仅一项试验提供了持续妊娠率，该试验比较了立即下床活动与卧床休息30分钟的效果，未发现卧床休息有效果（比值比1.00；95%置信区间0.54至1.85）。除临床妊娠率在所有纳入试验中均有报告外，次要结局报告较少。较少卧床休息与较多卧床休息之间无显著差异（比值比1.13；95%置信区间0.77至1.67）。使用纤维蛋白密封剂与对照组之间也无显著差异（比值比0.98；95%置信区间0.54至1.78）。即便如此，与不干预相比，宫颈机械闭合后妊娠概率显著更高（比值比1.92；95%置信区间1.40至2.63）。纳入研究的偏倚风险各不相同。大多数试验展示了正确的随机化和分配隐藏方法，而仅一项试验报告采用了盲法。
没有足够证据支持胚胎移植后女性需要卧床一定时间，也不支持使用纤维蛋白密封剂。最后，支持胚胎移植后使用宫颈管机械闭合的证据有限。需要进一步设计良好且有足够效力的研究来确定这些及其他胚胎移植后技术对接受IVF和ICSI的女性的真实效果（如有）。
