口服避孕药对卵巢功能正常不育患者体外受精-胚胎移植妊娠结局影响的Meta分析

目的系统评价口服避孕药(OC)在卵巢储备功能正常不育患者IVF-ET治疗周期妊娠结局中的作用。方法计算机检索Cochrane Library、PubMed、Embase、Biomed Central、CNKI、维普(VIP)和万方数据库的原始论著,收集在IVFET治疗周期前,使用OC和不使用OC对患者妊娠结局影响的临床随机对照研究,同时筛选纳入文献的参考文献。根据Cochrane系统评价方法,由3名独立研究者对文献的质量进行严格的评价和信息提取,并通过RevMan5.2软件对符合质量标准的随机对照试验(RCT)进行Meta分析。结果本研究共纳入6个RCT文献,共计1 620例患者,其中1例退出;Meta分析结果显示:对卵巢功能正常不育患者在IVF-ET前使用OC预处理会使临床妊娠率降低RR=0.70,95%CI(0.55,0.88),P=0.002],继续妊娠率亦降低RR=0.70,95%CI(0.54,0.92),P=0.01],但是两组间获卵数WMD=0.53,95%CI(-1.20,2.26),P=0.55]、可移植胚胎数WMD=-0.14,95%CI(-0.40,0.11),P=0.27]、优胚数WMD=0.37,95%CI(-0.36,1.11),P=0.32]、种植率RR=0.98,95%CI(0.79,1.21),P=0.83]比较均无统计学意义。结论本研究结果表明,对于卵巢功能正常的不育患者,使用OC预处理并不显著改善其IVF-ET的妊娠结局,甚至可能会降低临床妊娠率和继续妊娠率。

Effect of oral contraceptives on IVF-ET outcome of patients with normal ovarian function:a meta-analysis

Objective： To ealuate the efficacy of oral contraceptives on IVF-ET outcomes in patients with normal ovarian function who underwent in vitro fertilization. Methods. Databases such as Cochrane Library, PubMed, Embase, Biomed Central, CNKI, VIP, Wanfang database were searched for the related studies in randomized controlled trials（RCT）to evaluate whether oral contraceptives could improve IVF-ET outcomes in patients with normal ovarian function. The included literature references were also screened at the same time. The methodological quality of the included RCT was assessed and the data were extracted by three researchers according to the Cochrane Handbook. Meta-analysis was performed by using RevMan 5.2 s＇0ftware. Results： The study included Six RCTs, a total of 1 620 patients including ohe exit. Meta analysis showed that pretreatment with oral contraceptives was associated with decrease in clinical pregnancy rate RR=0. 71, 95% CI （ 0. 56, 0. 89 ） , P =- 0. 003 ] and ongoing pregnancy rate RR=0.70,95%）CI（0.54, 0.92） ,P= O. 01]. No significant differences in total number of oocytes WMD = 0.65,95% CI（-0.92,2.23）,P=0.42% ,total number of embryos WMD=0. 13,95%CI（-0.50,0.76）,P=0.68] ,number of good quality embryos WMD=O. 37,95%CI（-0.36,1.11）,P=0. 32],and implantation rate -RR=0.98,95GCI （0.79,1.21）,P=0.83] were found between the study and control group. Conclusions： The results of this study show that oral contraceptives pretreatment does not improve pregnancy outcome, and it may reduce the clinical pregnancy rate and ongoing pregnancy rate in patients with normal ovarian function.