Gao Yinjie, Yu Bingqing, Mao Jiangfeng, Wang Xi, Nie Min, Wu Xueyan
Key laboratory of Endocrinology, Ministry of Health; Department of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Wang Fu Jing St, Dongcheng district, Beijing, 100730, China.
BMC Endocr Disord. 2018 Nov 19;18(1):85. doi: 10.1186/s12902-018-0313-8.
After hormonal replacement therapy (HRT) including androgen replacement or sequential therapy of estrogen and progesterone, The combination of human chorionic gonadotropin (hCG) and human menopausal gonadotropin (hMG) and pulsatile GnRH, is not sufficient to produce sufficient gametes in some patients with Congenital hypogonadotropic hypogonadism (CHH). A Systematic review and meta-analysis was performed to determine that assisted reproductive techniques (ART) can effectively treat different causes of infertility.
To determine the effect of ART on fertility of CHH patients and investigate whether outcomes are similar to infertility due to other causes, we conducted a systematic review and meta-analysis of retrospective trials. Clinical trials were systematically searched in Medline, Embase, and the Cochrane central register of controlled trials databases. The keywords and major terms covered "hypogonadotropic hypogonadism", "kallmann syndrome", "assisted reproductive techniques", "intrauterine insemination", "intracytoplasmic sperm injection", "testicular sperm extraction", "in vitro fertilization", "embryo transplantation" and "intra-Fallopian transfer".
A total of 388 pregnancies occurred among 709 CHH patients who received ART (effectiveness 46, 95% confidence interval 0.39 to 0.53) in the 20 studies we included. The I in trials assessing overall pregnancy rate (PR) per embryo transfer (ET) cycle was 73.06%. Similar results were observed in subgroup analysis by different gender. Regression indicates pregnancy rate decreases with increasing age. Fertilization, implantation and live birth rates (72, 36 and 40%) showed no significant differences as compared to infertility due to other causes.
Despite CHH patients usually being difficult to generate gametes, their actual chances of fertility are similar to subjects with other non-obstructive infertility. ART is a suitable option for CHH patients who do not conceive after long-term gonadotropin treatment.
在包括雄激素替代或雌激素与孕激素序贯治疗的激素替代疗法（HRT）后，人绒毛膜促性腺激素（hCG）与人绝经期促性腺激素（hMG）联合及脉冲式GnRH，在一些先天性低促性腺激素性性腺功能减退（CHH）患者中不足以产生足够的配子。进行了一项系统评价和荟萃分析以确定辅助生殖技术（ART）能否有效治疗不同原因的不孕症。
为确定ART对CHH患者生育力的影响并调查其结果是否与其他原因导致的不孕症相似，我们对回顾性试验进行了系统评价和荟萃分析。在Medline、Embase和Cochrane对照试验中心注册库数据库中系统检索临床试验。关键词和主要术语涵盖“低促性腺激素性性腺功能减退”“卡尔曼综合征”“辅助生殖技术”“宫内人工授精”“卵胞浆内单精子注射”“睾丸精子提取”“体外受精”“胚胎移植”和“输卵管内移植”。
在我们纳入的20项研究中，709例接受ART的CHH患者共发生388次妊娠（有效性46，95%置信区间0.39至0.53）。评估每个胚胎移植（ET）周期总体妊娠率（PR）的试验中的I为73.06%。在按不同性别进行的亚组分析中观察到类似结果。回归分析表明妊娠率随年龄增长而降低。与其他原因导致的不孕症相比，受精、着床和活产率（分别为72%、36%和40%）无显著差异。
尽管CHH患者通常难以产生配子，但他们实际的生育机会与其他非梗阻性不孕症患者相似。ART是长期促性腺激素治疗后仍未受孕的CHH患者的合适选择。
