Medical treatment before in-vitro fertilization in patients with adenomyosis: a systematic review and meta-analysis.

IF 3.2 3区 医学 Q2 GENETICS & HEREDITY
Giulia Galati, Carlotta Olivieri, Martina Cosentino, Ilham Azenkoud, Sara Cugini, Giuseppe Sorrenti, Giuseppe Rizzo, Ludovico Muzii
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Abstract

The objective of this study is to evaluate if medical treatment before assisted reproductive technology (ART) improves the results in infertile patients with adenomyosis. A literature search was performed with EMBASE, PubMed, and Cochrane. The primary outcome was clinical pregnancy rate (CPR). Secondary outcomes were live birth rate (LBR) per cycle and miscarriage rate (MR) after ART with or without medical pretreatment. Additionally, a comparison was made between women undergoing medical pretreatment before frozen embryo transfer (FET) and those who underwent FET alone, including any type of endometrial preparation. Ten studies were included. The present meta-analysis supports the use of long-term GnRH agonist therapy in patients with adenomyosis, which enhances the CPR (odds ratio (OR) 1.49, 95% CI 1.15 to 1.92) in IVF/ICSI with fresh ET, while the comparison in women undergoing FET cycles did not reach statistical significance (OR 1.34 95% CI 0.70-2.55). Pretreatment with GnRH agonist did not demonstrate a benefit on the LBR and MR per cycle in IVF/ICSI with fresh ET in comparison to standard ovarian stimulation protocols. Similar results were observed in the setting of FET, failing to indicate a superiority of GnRH agonist pretreatment over standard FET protocols for LBR and MR. In conclusion, GnRH agonist pretreatment before ART carries a potential benefit in improving outcomes in terms of higher CPR, but there is no significant impact on LBR and MR. Pretreatment with GnRH agonists could be adopted as a possible alternative ART protocol in selected patients with adenomyosis and infertility.

子宫腺肌症患者体外受精前的药物治疗:系统回顾和荟萃分析
本研究的目的是评估辅助生殖技术(ART)前的药物治疗是否能改善子宫腺肌症不孕患者的结果。通过EMBASE、PubMed和Cochrane进行文献检索。主要观察指标为临床妊娠率(CPR)。次要结局是每个周期的活产率(LBR)和ART后有或没有药物预处理的流产率(MR)。此外,还对冷冻胚胎移植(FET)前接受药物预处理的妇女和单独接受FET(包括任何类型的子宫内膜准备)的妇女进行了比较。纳入了10项研究。本荟萃分析支持子宫腺肌症患者长期使用GnRH激动剂治疗,可提高新鲜ET IVF/ICSI患者的CPR(比值比(OR) 1.49, 95% CI 1.15至1.92),而接受FET周期的女性的比较无统计学意义(OR 1.34 95% CI 0.70-2.55)。与标准卵巢刺激方案相比,GnRH激动剂预处理未显示出对新鲜ET IVF/ICSI中每个周期LBR和MR的益处。在FET的情况下也观察到类似的结果,未能表明GnRH激动剂预处理在LBR和mr方面优于标准FET方案。总之,在ART前GnRH激动剂预处理在提高心肺复苏率方面具有潜在的益处,但对LBR和mr没有显着影响,GnRH激动剂预处理可以作为选择的子宫腺肌症和不孕症患者的替代ART方案。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
5.70
自引率
9.70%
发文量
286
审稿时长
1 months
期刊介绍: The Journal of Assisted Reproduction and Genetics publishes cellular, molecular, genetic, and epigenetic discoveries advancing our understanding of the biology and underlying mechanisms from gametogenesis to offspring health. Special emphasis is placed on the practice and evolution of assisted reproduction technologies (ARTs) with reference to the diagnosis and management of diseases affecting fertility. Our goal is to educate our readership in the translation of basic and clinical discoveries made from human or relevant animal models to the safe and efficacious practice of human ARTs. The scientific rigor and ethical standards embraced by the JARG editorial team ensures a broad international base of expertise guiding the marriage of contemporary clinical research paradigms with basic science discovery. JARG publishes original papers, minireviews, case reports, and opinion pieces often combined into special topic issues that will educate clinicians and scientists with interests in the mechanisms of human development that bear on the treatment of infertility and emerging innovations in human ARTs. The guiding principles of male and female reproductive health impacting pre- and post-conceptional viability and developmental potential are emphasized within the purview of human reproductive health in current and future generations of our species. The journal is published in cooperation with the American Society for Reproductive Medicine, an organization of more than 8,000 physicians, researchers, nurses, technicians and other professionals dedicated to advancing knowledge and expertise in reproductive biology.
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