Department of Women and Children's Health, Unit of Gynaecology and Obstetrics, University of Padua, Padua, Italy.
Department of Neuroscience Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy.
BJOG. 2019 Jan;126(2):167-175. doi: 10.1111/1471-0528.15269. Epub 2018 Jun 3.
Several randomised controlled trials (RCTs) have investigated the usefulness of pituitary block with gonadotrophin-releasing hormone (GnRH) antagonists during intrauterine insemination (IUI) cycles, with conflicting results.
The aim of the present systematic review and meta-analysis of RCTs was to evaluate the effectiveness of GnRH antagonist administration as an intervention to improve the success of IUI cycles.
Electronic databases (MEDLINE, Scopus, EMBASE, Sciencedirect) and clinical registers were searched from their inception until October 2017.
Randomised controlled trials of infertile women undergoing one or more IUI stimulated cycles with GnRH antagonists compared with a control group.
The primary outcomes were ongoing pregnancy/live birth rate (OPR/LBR) and clinical pregnancy rate (CPR). Pooled results were expressed as odds ratio (OR) or mean differences with 95% confidence interval (95% CI). Sources of heterogeneity were investigated through sensitivity and subgroups analysis. The body of evidence was rated using GRADE methodology. Publication bias was assessed with funnel plot, Begg's and Egger's tests.
Fifteen RCTs were included (3253 IUI cycles, 2345 participants). No differences in OPR/LBR (OR 1.14, 95% CI 0.82-1.57, P = 0.44) and CPR (OR 1.28, 95% CI 0.97-1.69, P = 0.08) were found. Sensitivity and subgroup analyses did not provide statistical changes in pooled results. The body of evidence was rated as low (GRADE 2/4). No publication bias was detected.
Pituitary block with GnRH antagonists does not improve OPR/LBR and CPR in women undergoing IUI cycles.
Pituitary block with GnRH antagonists does not improve the success of IUI cycles.
几项随机对照试验（RCTs）已经研究了在宫腔内人工授精（IUI）周期中使用促性腺激素释放激素（GnRH）拮抗剂进行垂体阻断的有用性，但结果相互矛盾。
本系统评价和 RCTs 的荟萃分析旨在评估 GnRH 拮抗剂给药作为改善 IUI 周期成功率的干预措施的有效性。
从成立之初到 2017 年 10 月，电子数据库（MEDLINE、Scopus、EMBASE、Sciencedirect）和临床登记册进行了搜索。
接受 GnRH 拮抗剂治疗的不孕妇女进行一次或多次 IUI 刺激周期的随机对照试验，与对照组进行比较。
主要结局是持续妊娠/活产率（OPR/LBR）和临床妊娠率（CPR）。汇总结果表示为优势比（OR）或均数差异与 95%置信区间（95%CI）。通过敏感性和亚组分析调查异质性来源。使用 GRADE 方法对证据体进行评级。使用漏斗图、贝格和埃格检验评估发表偏倚。
纳入了 15 项 RCT（3253 次 IUI 周期，2345 名参与者）。在 OPR/LBR（OR 1.14，95%CI 0.82-1.57，P=0.44）和 CPR（OR 1.28，95%CI 0.97-1.69，P=0.08）方面没有差异。敏感性和亚组分析并没有改变汇总结果的统计学意义。证据体被评为低（GRADE 2/4）。未发现发表偏倚。
在接受 IUI 周期的妇女中，使用 GnRH 拮抗剂进行垂体阻断不会提高 OPR/LBR 和 CPR。
使用 GnRH 拮抗剂进行垂体阻断不会提高 IUI 周期的成功率。
