试管婴儿与IUI与卵巢刺激无法解释的不孕症:一个协作的个人参与者数据元分析
Shimona Lai1, Rui Wang1, Madelon van Wely2,3
1Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia.
Human reproduction update
|December 26, 2023
概括
试管婴儿 (IVF) 和卵巢刺激的子宫内授精 (IUI-OS) 显示,无法解释的不孕症的活产率相似. 两种治疗都没有显著减少怀孕的时间或多胎妊娠率.
科学领域:
- 生殖内分泌学 生殖内分泌学
- 不孕症管理 不孕症管理
- 临床试验 临床试验
背景情况:
- 在考虑体外受精 (IVF) 之前,无法解释的不孕症管理通常遵循一个逐步的方法,以卵巢刺激 (IUI-OS) 的宫内授精作为一线治疗.
- 由于感知到更高的活产率和更短的怀孕时间,人们对立即试管婴儿越来越感兴趣.
研究的目的:
- 为了比较IVF和IUI-OS的累积活产率,在没有解释的不孕症的夫妇中.
- 与IUI-OS相比,研究IVF是否能缩短怀孕的时间,降低多胎妊娠率.
- 通过使用个人参与者数据来解决先前的元分析的局限性,用于标准化后续和时间到事件分析.
主要方法:
- 进行了个人参与者数据元分析 (IPD-MA).
- 在多个数据库 (MEDLINE,EMBASE等) 进行了搜索. 对于相关的随机对照试验 (RCT) 至2023年1月.
- 包括RCT比较IVF/ICSI与IUI-OS在不明原因的不孕不育,综合了四项试验中的934名妇女的数据.
主要成果:
- 与IUI-OS相比,试管婴儿的累积活产率并没有显著上升 (50.3%对43.2%).
- 试管婴儿并没有显著减少导致活产的怀孕时间.
- 与IUI-OS组相比,试管婴儿组的多胎妊娠率并没有显著下降 (3.8%对5.2%).
结论:
- 目前的强有力的证据不支持试管婴儿比IUI-OS更快地在无法解释的不孕症中实现活产.
- 试管婴儿和IUI-OS都是治疗不明原因不孕症的有效和安全选择.
- 临床决策应考虑干预成本和患者偏好,以及有效性和安全性数据.
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