预测接受辅助生殖技术的患者妊娠结局的子宫内膜压实度:系统综述和荟萃分析。

IF 8.3 Q1 OBSTETRICS & GYNECOLOGY
Human reproduction open Pub Date : 2024-06-20 eCollection Date: 2024-01-01 DOI:10.1093/hropen/hoae040
Hannan Al-Lamee, Katie Stone, Simon G Powell, James Wyatt, Andrew J Drakeley, Dharani K Hapangama, Nicola Tempest
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引用次数: 0

摘要

研究问题:子宫内膜压实度(EC)是否有助于预测接受抗逆转录病毒疗法者的妊娠结局?EC与较高的临床妊娠率(CPR)和持续妊娠率(OPR)有关,但这并不意味着活产率(LBR):EC是指在胚胎移植前的增殖期结束后,可观察到由孕激素引起的子宫内膜厚度的减少。EC被认为是一种非侵入性工具,有助于预测接受抗逆转录病毒疗法者的妊娠结局,但已发表的数据却相互矛盾:由两位独立作者使用 PubMed、Cochrane Library、MEDLINE、Embase、Science Direct、Scopus 和 Web of Science 进行文献检索,检索时间从数据库建立之初至 2023 年 5 月。所有报道接受体外受精(IVF)/卵胞浆内单精子显微注射(ICSI)治疗的患者的EC和妊娠结局的同行评审研究均被纳入其中:主要结果为LBR。次要结果包括其他妊娠指标(妊娠试验阳性(PPT)、CPR、OPR、流产率(MR))和EC率。如果 I 2 > 50%,则采用随机效应模型对每项结果进行 EC 与无 EC 的比较荟萃分析。曼特尔-汉斯泽尔法(Mantel-Haenszel)用于汇总二分法数据。结果以几率比(OR)和 95% CI 表示:在筛选出的 4030 篇文章中,有 21 项队列研究被纳入最终分析(n = 27 857)。EC组与无EC组的LBR无明显差异(OR 0.95; 95% CI 0.87-1.04)。EC组的OPR明显更高(OR 1.61;95% CI 1.09-2.38),尤其是当EC≥15%时与无EC组相比(OR 3.52;95% CI 2.36-5.23)。各研究对 CPR 的定义不一致,影响了研究结果。当定义为可行宫内妊娠时,需要谨慎:由于报告的妊娠结果、EC定义、超声检查方法和周期方案的不同而导致的异质性可能是CPR/OPR和LBR结果之间缺乏转化的原因;因此,所有汇总数据都应谨慎看待:在该数据集中,EC 的 CPR/OPR 明显高于 LBR。虽然目前还不能建议在临床实践中根据 EC 对妇女进行分层,但有必要进行一项大型、设计良好的临床试验,以严格评估 EC 作为成功妊娠的无创预测指标的作用。我们敦促在抗逆转录病毒疗法试验中强制执行一致的结果报告,以便对数据进行汇总、比较和总结:H.A.得到了休伊特生育中心的支持。S.G.P.和J.W.得到了利物浦大学医院NHS基金会的支持。D.K.H.获得了Wellbeing of Women项目基金(RG2137)和MRC临床研究培训奖学金(MR/V007238/1)的支持。N.T.得到了国家健康与护理研究所的支持。D.K.H.获得了Theramex公司的顾问酬金,并从Theramex公司和Gideon Richter公司获得了演讲报酬。其余作者没有需要报告的利益冲突:ProCORMBERCO CRD42022378464.
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Endometrial compaction to predict pregnancy outcomes in patients undergoing assisted reproductive technologies: a systematic review and meta-analysis.

Study question: Does endometrial compaction (EC) help predict pregnancy outcomes in those undergoing ART?

Summary answer: EC is associated with a significantly higher clinical pregnancy rate (CPR) and ongoing pregnancy rate (OPR), but this does not translate to live birth rate (LBR).

What is known already: EC describes the progesterone-induced decrease in endometrial thickness, which may be observed following the end of the proliferative phase, prior to embryo transfer. EC is proposed as a non-invasive tool to help predict pregnancy outcome in those undergoing ART, however, published data is conflicting.

Study design size duration: A literature search was carried out by two independent authors using PubMed, Cochrane Library, MEDLINE, Embase, Science Direct, Scopus, and Web of Science from inception of databases to May 2023. All peer-reviewed studies reporting EC and pregnancy outcomes in patients undergoing IVF/ICSI treatment were included.

Participants/materials setting methods: The primary outcome is LBR. Secondary outcomes included other pregnancy metrics (positive pregnancy test (PPT), CPR, OPR, miscarriage rate (MR)) and rate of EC. Comparative meta-analyses comparing EC and no EC were conducted for each outcome using a random-effects model if I 2 > 50%. The Mantel-Haenszel method was applied for pooling dichotomous data. Results are presented as odds ratios (OR) with 95% CI.

Main results and the role of chance: Out of 4030 screened articles, 21 cohort studies were included in the final analysis (n = 27 857). No significant difference was found between LBR in the EC versus the no EC group (OR 0.95; 95% CI 0.87-1.04). OPR was significantly higher within the EC group (OR 1.61; 95% CI 1.09-2.38), particularly when EC ≥ 15% compared to no EC (OR 3.52; 95% CI 2.36-5.23). CPR was inconsistently defined across the studies, affecting the findings. When defined as a viable intrauterine pregnancy <12 weeks, the EC group had significantly higher CPR than no EC (OR 1.83; 95% CI 1.15-2.92). No significant differences were found between EC and no EC for PPT (OR 1.54; 95% CI 0.97-2.45) or MR (OR 1.06; 95% CI 0.92-1.56). The pooled weighted incidence of EC across all studies was 32% (95% CI 26-38%).

Limitations reasons for caution: Heterogeneity due to differences between reported pregnancy outcomes, definition of EC, method of ultrasound, and cycle protocol may account for the lack of translation between CPR/OPR and LBR findings; thus, all pooled data should be viewed with an element of caution.

Wider implications of the findings: In this dataset, the significantly higher CPR/OPR with EC does not translate to LBR. Although stratification of women according to EC cannot currently be recommended in clinical practice, a large and well-designed clinical trial to rigorously assess EC as a non-invasive predictor of a successful pregnancy is warranted. We urge for consistent outcome reporting to be mandated for ART trials so that data can be pooled, compared, and concluded on.

Study funding/competing interests: H.A. was supported by the Hewitt Fertility Centre. S.G.P. and J.W. were supported by the Liverpool University Hospital NHS Foundation Trust. D.K.H. was supported by a Wellbeing of Women project grant (RG2137) and MRC clinical research training fellowship (MR/V007238/1). N.T. was supported by the National Institute for Health and Care Research. D.K.H. had received honoraria for consultancy for Theramex and has received payment for presentations from Theramex and Gideon Richter. The remaining authors have no conflicts of interest to report.

Registration number: PROSPERO CRD42022378464.

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