Shirlow Rachael, Healey Martin, Volovsky Michelle, MacLachlan Vivien, Vollenhoven Beverley
Monash University, Melbourne, Australia.
Monash Health, Melbourne, Australia.
J Reprod Infertil. 2017 Oct-Dec;18(4):368-378.
Many adjuvant therapies are employed during IVF treatment in an attempt to improve outcomes. The objective of our study was to evaluate the impact of thirteen adjuvants (Intralipid, steroids, melatonin, coenzyme Q10, Filgrastim, testosterone, DHEA, growth hormone, antibiotics, hCG infusion, aspirin, enoxaparin/heparin and dopamine agonists) on the success of embryo transfers.
This is a retrospective cohort study of all embryo transfers between January 2010 and April 2015 from a multi-site IVF clinic. To ensure data independence, random number was applied to each included transfer and used to pick an individual transfer for each patient (n=13,372). Outcomes were clinical pregnancy, live birth and pregnancy loss. Univariate comparison with Chi square testing and logistic regression analysis were used. The level of significance was p<0.05.
Steroid use was significantly associated with both reduced clinical pregnancy loss (aOR 0.39, CI 0.19-0.76) and improved live birth rates (aOR 1.40, CI 1.11-1.77). While aspirin was associated with improved live birth rates (aOR 1.48, CI 1.08-2.02), melatonin was linked with reduced rates (aOR 0.66, CI 0.45-0.96). Analyses for all other adjuvant therapies did not reach statistical significance after logistic regression.
Many of the interventions investigated in this study fail to significantly demonstrate any effects on the success of embryo transfers. Our analysis results show negative effects with the use of melatonin; however, use of aspirin or steroids demonstrated promising, potentially beneficial outcomes. Additional exploration is needed to guide evidence-based practice.
在体外受精（IVF）治疗过程中会采用多种辅助治疗方法以改善治疗效果。我们研究的目的是评估13种辅助剂（脂肪乳剂、类固醇、褪黑素、辅酶Q10、非格司亭、睾酮、脱氢表雄酮、生长激素、抗生素、人绒毛膜促性腺激素（hCG）输注、阿司匹林、依诺肝素/肝素和多巴胺激动剂）对胚胎移植成功率的影响。
这是一项对2010年1月至2015年4月间来自一家多中心IVF诊所的所有胚胎移植进行的回顾性队列研究。为确保数据独立性，对每个纳入的移植病例应用随机数，并用于为每位患者挑选一次单独的移植病例（n = 13372）。观察指标为临床妊娠、活产和妊娠丢失。采用卡方检验进行单因素比较并进行逻辑回归分析。显著性水平为p < 0.05。
使用类固醇与临床妊娠丢失率降低（调整后比值比[aOR] 0.39，可信区间[CI] 0.19 - 0.76）和活产率提高（aOR 1.40，CI 1.11 - 1.77）均显著相关。阿司匹林与活产率提高相关（aOR 1.48，CI 1.08 - 2.02），而褪黑素与活产率降低相关（aOR 0.66，CI 0.45 - 0.96）。逻辑回归分析后，所有其他辅助治疗方法的分析均未达到统计学显著性。
本研究中所调查的许多干预措施未能显著证明对胚胎移植成功率有任何影响。我们的分析结果显示使用褪黑素存在负面影响；然而，使用阿司匹林或类固醇显示出有前景的、潜在有益的结果。需要进一步探索以指导循证实践。
