First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China.
Department of Reproductive Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China.
Front Endocrinol (Lausanne). 2023 Mar 23;14:1161707. doi: 10.3389/fendo.2023.1161707. eCollection 2023.
Repeated embryo implantation failure (RIF) posed a significant challenge in assisted reproduction. Evidence of its therapeutic effectiveness including atosiban used around embryo transfer to improve pregnancy outcomes in RIF patients undergoing fertilization-embryo transfer (IVF-ET) remained inconsistent. This study aimed to explore the efficacy of atosiban on pregnancy outcomes of patients with RIF who received IVF-ET.
The research was designed using the PICOS format. A systematic search of four English databases, PubMed, EMBASE, Web of Science, Cochrane Library, and one Chinse database, China National Knowledge Infrastructure (CNKI) was conducted. The time range was from inception to December 10, 2022. Then trials comparing the efficacy of atosiban and control group on pregnancy outcomes in RIF patients who receive IVF-ET were included. Subgroup analysis and sensitivity analysis were performed to reduce the influence of heterogeneity between included studies. Risk ratio (RR) and 95% confidence interval (CI) were calculated. The main outcome measure was clinical pregnancy rate (CPR). For the analyses, StataMP 17.0 (Stata Corporation, USA) was used.
Two prospective randomized controlled trials (RCTs), one prospective cohort study and four retrospective cohort studies were included. Our results showed that atosiban was associated with higher clinical pregnancy rate (RR=1.54, 95% CI: 1.365-1.735, < 0.001, I 0.0%). The results of subgroup analysis based on study types (prospective randomized controlled clinical trial, retrospective cohort study and prospective cohort study) showed that in all types of studies, CPR of atosiban group was significantly higher than controlled group. The results of subgroup analysis based upon the diagnostic criteria of number of previous embryo transfer failures showed that the intervention of atosiban improved the CPR whether in participants with 2 previous ET failures or in participants with 3 previous ET failures. Nevertheless, the incidence of ectopic pregnancy, multiple pregnancy, and miscarriages were not significantly different between the case and control groups.
For women who are undergoing IVF-ET and have experienced repeated embryo implantation failure, atosiban may be an important factor in enhancing pregnancy outcomes. To confirm this conclusion, more thorough, prospective randomized controlled studies of sizable sample sizes with well design are required.
反复胚胎着床失败（RIF）对辅助生殖提出了重大挑战。阿托西班在胚胎移植前后用于改善接受体外受精-胚胎移植（IVF-ET）的 RIF 患者的妊娠结局的治疗效果的证据仍不一致。本研究旨在探讨阿托西班对接受 IVF-ET 的 RIF 患者妊娠结局的影响。
研究采用 PICOS 格式。系统检索了 4 个英文数据库（PubMed、EMBASE、Web of Science、Cochrane Library）和 1 个中文数据库（中国知网，CNKI），检索时间范围为建库至 2022 年 12 月 10 日。然后纳入比较阿托西班组与对照组对接受 IVF-ET 的 RIF 患者妊娠结局影响的试验。进行亚组分析和敏感性分析，以减少纳入研究之间异质性的影响。计算风险比（RR）和 95%置信区间（CI）。主要观察指标为临床妊娠率（CPR）。使用 StataMP 17.0（Stata Corporation，USA）进行分析。
纳入了 2 项前瞻性随机对照试验（RCT）、1 项前瞻性队列研究和 4 项回顾性队列研究。我们的结果表明，阿托西班与更高的临床妊娠率相关（RR=1.54，95%CI：1.365-1.735，<0.001，I 0.0%）。基于研究类型（前瞻性随机对照临床试验、回顾性队列研究和前瞻性队列研究）的亚组分析结果表明，在所有类型的研究中，阿托西班组的 CPR 均显著高于对照组。基于既往胚胎移植失败次数的诊断标准的亚组分析结果表明，阿托西班的干预改善了 2 次或 3 次 ET 失败患者的 CPR。然而，病例组和对照组之间异位妊娠、多胎妊娠和流产的发生率无显著差异。
对于接受 IVF-ET 且经历反复胚胎着床失败的女性，阿托西班可能是提高妊娠结局的重要因素。为了证实这一结论，需要进行更多设计良好的、大样本量的、更彻底的前瞻性随机对照研究。
