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Published on: January 22, 2022
Interventions for endometriosis-related infertility: a systematic review and network meta-analysis
Ruth Mary Hodgson1, Hui Linn Lee2, Rui Wang3
1Department of Obstetrics and Gynaecology, Cairns Hospital, Cairns, Queensland, Australia.
Objective:
To compare the effectiveness of different treatments for women with endometriosis-related infertility.
Design:
A systematic review and network meta-analysis of randomized controlled trials (RCTs).
Setting:
Not applicable.
Patient(S):
Women with endometriosis confirmed by laparoscopy with associated infertility.
Intervention(S):
An extensive electronic search of the following databases: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, ClinicalTrials.gov, and Embase.
Main Outcome Measure(S):
Clinical pregnancy, live birth rate, miscarriage, and adverse events.
Result(S):
A total of 4,252 trials/abstracts were identified through the literature search, of which we included 36 trials in the systematic review and 26 trials reporting on 2,245 women with endometriosis-related infertility in the network meta-analysis. Network meta-analysis showed that compared with placebo, surgical laparoscopy alone (odds ratio = 1.63; 95% confidence interval, 1.13-2.35) or GnRH agonist alone (odds ratio = 1.68; 95% confidence interval, 1.07-2.46) results in higher odds of pregnancy. The evidence on the other interventions versus placebo or on the secondary outcomes including live birth, miscarriage, and adverse events is insufficient.
Conclusion(S):
The most important conclusion is that more RCTs are needed to clarify the relative effectiveness of treatments for endometriosis-related infertility, ideally comparing interventions to existing recommended interventions such as surgical laparoscopy. In addition, further RCTs comparing IVF and IUI to other treatments are essential.
Registration Number:
PROSPERO registration number, CRD42018087572.
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