新鲜胚胎与全冷冻胚胎——移植策略：一项荟萃分析的细微差别
Fresh embryos versus freeze-all embryos - transfer strategies: Nuances of a meta-analysis.
作者信息
Dieamant Felipe C, Petersen Claudia G, Mauri Ana L, Comar V, Mattila Mariana, Vagnini Laura D, Renzi Adriana, Petersen Bruna, Nicoletti Andreia, Oliveira João Batista A, Baruffi Ricardo Lr, Franco Jose G
机构信息
Center for Human Reproduction Prof. Franco Jr., Ribeirão Preto, Brazil.
Paulista Center for Diagnosis, Research and Training, Ribeirão Preto, SP, Brazil.
出版信息
JBRA Assist Reprod. 2017 Sep 1;21(3):260-272. doi: 10.5935/1518-0557.20170048.
OBJECTIVE
The present meta-analysis aimed to evaluate whether the freeze-all strategy (Freeze/All-ET) could bring about improvements in the clinical assisted reproductive technique (ART) outcomes when compared with the fresh embryo transfer strategy (Fresh-ET) in patients undergoing an ART cycle in accordance with the mean number of oocytes collected.
METHODS
A systematic review based on electronic searches in databases (PubMed, EMBASE, Web of Science, SCOPUS, and Cochrane Central Register of Controlled Trials) was carried out to identify randomized controlled trails (RCTs) comparing ART outcomes between fresh-embryo transfers versus elective frozen-embryo transfers up to February of 2017. Four reviewers independently evaluated abstracts, validity assessment and data extraction. Odds Ratio (OR) values with a 95% confidence interval (CI), and heterogeneity were evaluated.
RESULTS
Five RCTs were included as targets for data extraction and meta-analysis purposes. The results of this meta-analysis were divided into two parts (Freeze/All-ET versus Fresh-ET): Part I- All trials in which the mean number of collected oocytes was >12 and <21 for ongoing pregnancy rate (OR=1.24; 95%CI=1.06-1.44), clinical pregnancy rate (OR=1.19; 95%CI=0.98-1.43), live birth rate (OR= 1.39; 95%CI=0.99-1.95), and miscarriage rate (OR=0.68; 95%CI=0.46-1.00); Part II- Three studies where the mean number of oocytes retrieved was >12 and <15 for ongoing pregnancy rate (OR=1.17; 95%CI=1.00-1.38), clinical pregnancy rate (OR=1.34; 95%CI=0.79-2.28), live birth rate (OR= 1.24; 95%CI=1.00-1.55), and miscarriage rate (RR=0.68; 95%CI=0.46-1.02).
CONCLUSIONS
The freeze-all strategy could be favorable when high numbers of oocytes are collected, signaling an association between higher ovarian stimulation and consequent impairment of endometrial receptivity. However, when the mean number of oocytes collected is <15, the freeze-all strategy does not appear to be advantageous.
目的
本荟萃分析旨在评估在接受辅助生殖技术（ART）周期的患者中，根据收集的卵母细胞平均数，与新鲜胚胎移植策略（Fresh-ET）相比，全冷冻策略（Freeze/All-ET）是否能改善临床辅助生殖技术（ART）结局。
方法
基于数据库（PubMed、EMBASE、Web of Science、SCOPUS和Cochrane对照试验中央注册库）的电子检索进行系统评价，以识别比较截至2017年2月新鲜胚胎移植与选择性冷冻胚胎移植之间ART结局的随机对照试验（RCT）。四位评价者独立评估摘要、有效性评估和数据提取。评估比值比（OR）值及95%置信区间（CI）和异质性。
结果
纳入五项RCT作为数据提取和荟萃分析的对象。本荟萃分析结果分为两部分（Freeze/All-ET与Fresh-ET）：第一部分——所有收集的卵母细胞平均数>12且<21的试验，持续妊娠率（OR=1.24；95%CI=1.06-1.44）、临床妊娠率（OR=1.19；95%CI=0.98-1.43）、活产率（OR=1.39；95%CI=0.99-1.95）和流产率（OR=0.68；95%CI=0.46-1.00）；第二部分——三项收集的卵母细胞平均数>12且<15的研究，持续妊娠率（OR=1.17；95%CI=1.00-1.38）、临床妊娠率（OR=1.34；95%CI=0.79-2.28）、活产率（OR=1.24；95%CI=1.00-1.55）和流产率（RR=0.68；95%CI=0.46-1.02）。
结论
当收集的卵母细胞数量较多时，全冷冻策略可能更有利，这表明较高的卵巢刺激与随之而来的子宫内膜容受性受损之间存在关联。然而，当收集的卵母细胞平均数<15时，全冷冻策略似乎并无优势。
Zotero 插件